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Han: Role of Transarterial Embolization in the Management of Urologic Diseases
Urologic Intervention
Review Article

Journal of the Korean Society of Radiology 2019; 80(4): 643-655.

Published online: 30 July 2019

DOI: https://doi.org/10.3348/jksr.2019.80.4.643

Role of Transarterial Embolization in the Management of Urologic Diseases

Kichang Han, MD

Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.

Corresponding author: Kichang Han, MD. Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Tel 82-2-2228-7400, Fax 82-2-393-3035, wowsaycheese@hanmail.net

Received 1 May 2019       Revised 21 June 2019       Accepted 24 June 2019

Copyrights © 2019 The Korean Society of Radiology

The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Transarterial embolization has been widely utilized in the management of urologic diseases. Acute hemorrhage can be caused by tumor, trauma, and percutaneous procedures and is the most common indication for embolization. In the past, surgical intervention was the standard treatment for urological bleeding. However, it entailed high morbidity and mortality. The demand for less-invasive treatments led to the use of transarterial embolization as an alternative to surgery. Embolization is a safe and effective treatment option for hemorrhage in various urological organs. Additionally, embolization has been employed to prevent or treat hemorrhage associated with angiomyolipoma or to treat high-flow priapism. Embolization of the target vessel in a superselective manner and use of appropriate embolic materials are key to a safe and effective procedure.

Keywords: Hemorrhage, Embolization, Therapeutic, Urologic Neoplasm

Figures and Tables

Fig. 1

Patient who developed hematuria after partial nephrectomy for renal cell carcinoma.

A. CT reveals a pseudoaneurysm (arrow) arising from the renal artery.
B, C. Renal angiography demonstrates a pseudoaneurysm (arrow), which is superselected using a microcatheter.
D. The pseudoaneurysm was completely excluded after embolization using n-butyl cyanoacrylate glue.
jksr-80-643-g001
Fig. 2

Angiomyolipoma patient who complained of flank pain.

A. CT shows angiomyolipoma (*) in the upper pole of the left kidney.
B. Renal angiography demonstrates the tumor.
C. The lesion is superselected and embolized using polyvinyl alcohol particles (250–355 µm).
D. The tumor (*) decreases in size on the 6-month follow-up CT.
jksr-80-643-g002
Fig. 3

A 49-year-old male who developed hemorrhage after percutaneous renal biopsy.

A. CT reveals a pseudoaneurysm and hematoma in the kidney.
B. Renal angiography shows a pseudoaneurysm (arrow).
C. The affected branch is embolized using n-butyl cyanoacrylate glue and vascular plug.
D. Follow-up CT shows mild atrophy of the renal parenchyma, supplied by the embolized vessel. CT = computed tomography
jksr-80-643-g003
Fig. 4

Bladder cancer patient who complained of hematuria.

A. CT shows a tumor on the left side of the bladder.
B. The mass is opacified on left internal iliac angiography.
C. The feeding artery is superselected and embolized using Gelfoam.
jksr-80-643-g004
Fig. 5

A 34-year-old male who developed priapism.

A. Penile angiography shows contrast extravasation.
B. Embolization is performed using gelfoam.
jksr-80-643-g005
Table 1

Outcomes of Transarterial Embolization for Hemorrhage after Partial Nephrectomy

jksr-80-643-i001

*Presented as mean and range.

†Presented as median and range.

LPN = laparoscopic partial nephrectomy, OPN = open partial nephrectomy, RALPN = robot-assisted laparoscopic partial nephrectomy

Table 2

Outcomes of Transarterial Embolization for Vascular Injury Associated with Percutaneous Procedures

jksr-80-643-i002

NBCA = N-butyl cyanoacrylate, PCN = percutanous nephrostomy, PN = partial nephrectomy, PNL = pecutaneous nephrolithotomy, PVA = polyvinyl alcohol

Notes

Conflicts of Interest The author has no potential conflicts of interest to disclose.

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Kichang Han
https://orcid.org/0000-0002-9701-9757

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