Figure - available from: Case Reports in Urology
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Plain X-ray KUB showing right renal pelvic calculus with the stainless steel embolization coil within it and multiple calyceal stones (arrow). Left upper ureteric stone was also seen (straight line).
Source publication
Delayed bleeding following percutaneous nephrolithotomy (PCNL) usually occurs due to development of the pseudoaneurysm which can be successfully managed with coil embolization. However very few cases of such complications have been reported in the literature. Here we are reporting a case of delayed post-PCNL bleeding that occurred in a 53-year-old...
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Introduction
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Citations
... [3][4][5] There are a few examples of embolisation coils eroding into the collecting system and only one reported case of this occurring with Onyx. [6][7][8][9][10][11][12][13] We present a case of recurrent Onyx migration into the renal collecting system requiring ureteroscopic removal. ...
... 6 7 Others required ureteroscopy or percutaneous nephrolithotomy for removal. [8][9][10][11][12] The only other reported case of Onyx embolisation into the collecting system is described by Ierardi et al. Their patient was a man in his late 60s with a renal pseudoaneurysm secondary to trauma. ...
We present a case of Onyx embolisation of a renal pseudoaneurysm following partial nephrectomy with collecting system involvement with subsequent migration of Onyx into the renal collecting system resulting in renal obstruction. This occurred both immediately after embolisation and again 8 years after embolisation. Both cases required ureteroscopic surgical intervention. In the first instance, the pieces were removed using basket extraction. In the second, laser lithotripsy was used in addition to basket extraction. While there are a few cases of embolisation coils eroding into the renal collecting system, this is the second reported case of Onyx migration and the first where ureteroscopy with laser lithotripsy was used. The patient is doing well and undergoing surveillance ultrasounds to ensure there is no further Onyx migration. This may be a consideration for patients with pseudoaneurysm embolisation especially in the setting of prior collecting system damage.
... One of the most feared problems after a percutaneous nephrolithotomy is bleeding, with an estimated rate of 2%-20%. 4,5 Pseudoaneurysms of distal branches of the renal artery is a well-known complication, and has a reported incidence of 0.36%-1.0%. 2,4,6 Therapeutic angiography performed with stainless steel or titanium coils has evolved as the treatment of choice with success rates that exceed 90%. ...
... 2,4,6 Therapeutic angiography performed with stainless steel or titanium coils has evolved as the treatment of choice with success rates that exceed 90%. 4,7,8 The aim is to achieve a super selective embolization of the injured vessel. 4,9 Complications may occur during transarterial embolization as well as in the immediate perioperative period, as postembolization syndrome, renal insufficiency, embolization of nontarget organs, infective complications, and migration of embolization coils may appear. ...
... 4,7,8 The aim is to achieve a super selective embolization of the injured vessel. 4,9 Complications may occur during transarterial embolization as well as in the immediate perioperative period, as postembolization syndrome, renal insufficiency, embolization of nontarget organs, infective complications, and migration of embolization coils may appear. 4,10 Migration of coils and encrustation with renal calculi are compatible with reports of migrated coils acting as the nidus for stone formation. ...
Clinical presentation of patients with foreign bodies is highly variable. We received a 55-year-old female patient with fever and right flank pain. She was treated previously for kidney stones by percutaneous nephrolithtomy with partial resolution, requiring renal embolization during this procedure because of bleeding. CT evidenced metallic density images localized in kidney and ureter, associated with kidney stones located in lower calix. Semirigid ureteroscopy and retrograde intrarenal surgery were performed, revealing the presence of foreign bodies in both localizations and lower calix stones. Complete removal of foreign bodies and stones was performed. Foreign bodies were found to be embolization coils applied in the previous procedure.
... Embolization coil migration is a very rare complication reported in <2% of cases. The migration of coils in the collecting system is extremely rare, with only a few cases reported [1][2][3][4][5]. ...
... A stone formed around a wire coil was treated by ureteroscopy via pneumatic lithotripsy and grasps. Other reports are by Poyet et al. [4] and Kumar et al. [5]. The first one used a retrograde intrarenal approach to fragment the stone by holmium laser energy, and to extract the coil. ...
Percutaneous nephrolithotripsy (PCNL) has become a common procedure performed in patients with large renal calculi. Hemorrhage is the most frequent complication of this procedure. Transcatheter renal artery embolization is an effective and minimally invasive treatment option for acute renal bleeding but it is not without risks. In the case we describe, a big stone originated on embolization coils which migrated inside the renal pelvis after a previous PCNL and transcatheter artery embolization. We show that a new percutaneous approach is feasible and allows for the fragmentation of the stone and full clearance of fragments and coils.
... Though rare, migrated renal embolization coils have also been retrieved. [14][15][16][17] The removal of migrated coils has a high risk of causing significant bleeding and interventional radiologists may be prepared to treat such complications with simultaneous prone transradial arterial access. 18 Considerations Generally, percutaneous nephrostomy should be placed through Brodel's line to avoid vascular structures, but interventional radiology-operated nephroscopy (endoscopy of the kidney) or ureteroscopy for stone or foreign body removal should have percutaneous access that is ideal for the intervention. ...
Interventional radiologists perform a variety of image-guided procedures utilizing a variety of tools to create minimally invasive access into the biliary, gastrointestinal, and genitour-inary systems, as well as other structures. Endoscopy has been utilized by other specialists, namely gastroenterology and urology, to treat similar pathologies, but interventional radiology operated endoscopy has only been implemented at a few academic centers to date. The learning curve for an interventional radiologist to become proficient at endoscopic interventions is tempered by the technical dexterity and hand-eye coordination already required for other image-guided procedures. Moreover , the relative safety of endoscopy evidenced by the routine performance of laryngoscopy, bronchoscopy, eso-phagogastroduodenoscopy, colonoscopy, and cystoscopy at the bedside or in outpatient clinics supports its implementation by interventional radiologists. This article discusses the application of interventional radiology-operated endoscopy in the biliary, gastrointest-inal, and genitourinary systems (►Fig.
Renal pseudoaneurysm is a well-known albeit rare vascular complication following renal trauma, percutaneous interventions, renal biopsy, and partial nephrectomy. Angioembolization has become an effective treatment option for pseudoaneurysm using Cyanoacrylate glue, Gel-foams, Micro-coils, polyvinyl alcohol, etc. We herein present a 20-year-old gentleman with infected left hydroureteronephrosis secondary to an impacted foreign body in a ureter, specifically, down-migrated cyanoacrylate glue. This is two weeks following glue angioembolization for a left upper polar segmental renal artery pseudoaneurysm secondary to stab injury. He underwent a successful left-side ureteroscopic extraction of this polymerized glue, following which his symptoms subsided. These complications of glue migration following angioembolization are infrequent, and reports of it are scarce in the literature. Stringent follow-up and timely intervention are essential to mitigate disastrous outcomes.
Background: Selective renal artery angioembolization is the first treatment option in case of significant bleeding after percutaneous nephrolithotomy. Migration of embolization material into the collecting system is extremely rare. The treatment of this condition is not standardized, but manual extraction, ultrasound fragmentation, and holmium laser lithotripsy have been described.
Case presentation: We report the laser extraction of these coils in two patients at our center with two different approaches: retrograde intrarenal surgery (RIRS) and endoscopic combined intrarenal surgery (ECIRS). They were young male patients aged 25 and 29 years at the time of surgery, and they were 2–5 years postembolization when they presented to our center for symptoms such as hematuria and passage of small stone fragments. The first patient was managed solely with RIRS, whereas the second patient required ECIRS because of significant bleeding after coil removal, which necessitated hemostasis using a resectoscope.
Conclusion: For patients who present with recurrent stones or other symptoms such as pain, hematuria, or flank pain, the diagnosis of migrated embolization coils should be considered. Management can be via the retrograde or percutaneous approach, but in the setting of significant amount of migrated coils or significant bleeding after their removal, percutaneous access may allow more definitive hemostasis.
Endoscopy for the Interventional Radiologist: Literature Review and New Frontiers
Kidney stone disease is a complex disorder associated with a multitude of possible causes, among which metabolic and genetic components occupy an important position, being represented by hyperoxaluria, hypercalciuria, hypocitraturia, hyperuricemia, renal tubular acidosis, hypophosphatemia, cystinuria, etc. Other causes include: urinary infections, impaired drainage (i.e. obstruction), post-bariatric surgery, foreign bodies, drugs, etc. In many cases these factors are intermingling, necessitating a comprehensive clinical evaluation of the patient.
