Ces Urol 2000, 4(2):9-14 | DOI: 10.48095/cccu2000007

The strategy and management in treatment of postoperative bleeding following the retrograde endopyelotomy

O. Kőhler, P. Fencl

Urologické oddělení ÚVN Praha Radiodiagnostické oddělení ÚVN Praha

In the time period from 1995 till 1999 underwent 41 patients with obstructed pyeloureteral junction (30 cases of primary and 11 cases of secondary obstruction) the operation by technique of retrograde endopyelotomy. Two cases (4,9 %) of severe clinical bleeding requiring blood transfusions occurred.
In one female from those patients surgeons succeeded in angiographic detection of bleeding source from auxiliary polar artery crossing the pyeloureteral junction and they stopped the bleeding after use of the superselective embolisation. But the hemorrhage reoccurred after 14 days. The repeated embolisation has closed the auxiliary polar artery and thereafter no further bleeding occurred. The second female had history of repeated open procedures on pyeloureteral junction before the endopyelotomy. She underwent the preoperative angiographic examination and during the surgery the intraluminal sonography with the 10 MHz probe was used. No vessels were identified in the planned region of endoresection. The late hemorrhage appeared in the postoperative period, but the source of bleeding was not detected even by angiography. The repeated bleeding in this female patient was managed by conservative treatment. Authors discuss the reasons of bleeding development after endopyelotomy, its strategy and management.

Keywords: Retrograde endopyelotomy, Hemorrhage, Angiography, Superselective embolisation

Published: March 1, 2000