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Influence of symptomatic pseudoaneurysms on postoperative renal function after partial nephrectomy: results of a matched pair analysis

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Abstract

Purpose

A symptomatic pseudoaneurysm (SPA) is a rare but severe complication after partial nephrectomy (PN). Selective trans-arterial embolization (TAE) is the treatment of choice with high success rates. However, the influence of this intervention on postsurgical renal function has not been studied.

Methods

Between 2005 and 2016 we performed 1047 PNs at our institution. Postsurgical SPA occurred in 40 patients (3.8%). Patients with and without SPA were matched in a 1:2 ratio concerning tumor complexity (RENAL) and pre-operative renal function (CKD stage). Any CKD upstage and a relevant CKD progression (CKD ≥ III) were defined as endpoints. Furthermore, the influence of the amount of contrast agent applied during TAE was assessed.

Results

All patients with SPA were treated successfully with TAE. No significant difference could be detected concerning clinical, functional and surgical aspects. Median follow-up time accounted for 12.5 (6.75–27.5) months. Kaplan–Meier analyses detected an increased rate of any CKD upstage (p = 0.066) and relevant CKD progression (p = 0.01) in patients with SPA. Multivariate analysis identified post-operative SPA to be an independent predictor for a relevant CKD progression (HR 4.15, p = 0.01). The amount of contrast agents used did not have an impact on the development of a relevant CKD progression (p = 0.72).

Conclusion

Patients treated with TAE after PN show an additional risk for an impairment of renal function over time. Hence, those patients should explicitly be informed about possible consequences and closely monitored by nephrologists.

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Author notes

  1. P. Honeck and M.C. Kriegmair have equally contributed to this work.

Authors and Affiliations

  1. Department of Urology, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    M. T. Walach, D. Pfalzgraf, M. Ritter, M. S. Michel, N. Wagener, P. Honeck & M. C. Kriegmair

  2. Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    N. Rathmann & S. J. Diehl

  3. Department of Pathology, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    S. Porubsky

Authors
  1. M. T. Walach
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  2. N. Rathmann
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  3. S. Porubsky
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  4. D. Pfalzgraf
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  5. S. J. Diehl
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  6. M. Ritter
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  7. M. S. Michel
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  8. N. Wagener
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  9. P. Honeck
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  10. M. C. Kriegmair
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Contributions

MTW: Protocol/project development, Manuscript writing/editing, Data analysis, NR: Data collection/ critical revision and scientific input, SP: critical revision and scientific input, DP: critical revision and scientific input, SJD: critical revision and scientific input, MR: critical revision and scientific input, MSM: critical revision and scientific input, NW: critical revision and scientific input, PH: critical revision and scientific input, MCK: Protocol/project development, Manuscript writing/editing, Data analysis.

Corresponding author

Correspondence to M. T. Walach.

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Walach, M.T., Rathmann, N., Porubsky, S. et al. Influence of symptomatic pseudoaneurysms on postoperative renal function after partial nephrectomy: results of a matched pair analysis. Int Urol Nephrol 51, 33–40 (2019). https://doi.org/10.1007/s11255-018-2024-5

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  • DOI: https://doi.org/10.1007/s11255-018-2024-5

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