Delayed hematuria secondary to bleeding papilla--potential complication of laparoscopic partial nephrectomy

Urology. 2009 May;73(5):1163.e13-5. doi: 10.1016/j.urology.2008.03.048. Epub 2008 Jun 2.

Abstract

The complications of partial nephrectomy include hemorrhage, urinary leak, infection, formation of urinary fistula, and the development of renal insufficiency. We report a unique case of a patient who was found to have necrotic-appearing, bleeding, renal papillae after undergoing laparoscopic partial nephrectomy. A 66-year-old man was diagnosed with a left-sided, solid, enhancing, 2.5-cm, exophytic renal mass. Laparoscopic partial nephrectomy was performed, and the warm ischemia time was 31 minutes. He recovered uneventfully from surgery, but he started having episodes of gross hematuria approximately 5 months later. Computed tomography scan showed changes consistent with previous partial nephrectomy but no other abnormality. Ureterorenoscopy allowed us to identify several necrotic-appearing papillae in the same kidney that had undergone laparoscopic partial nephrectomy. A papilla in the lower pole was actively bleeding, and it was successfully obliterated using neodymium:yttrium-aluminum-garnet laser technology. Papillary necrosis can be a rare complication of laparoscopic or open partial nephrectomy. Additional study and close follow-up of patients who undergo partial nephrectomy is warranted.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Embolization, Therapeutic / methods
  • Follow-Up Studies
  • Hematuria / etiology*
  • Hematuria / physiopathology
  • Hematuria / therapy
  • Humans
  • Kidney Medulla / physiopathology*
  • Kidney Neoplasms / diagnosis
  • Kidney Neoplasms / surgery*
  • Laparoscopy / adverse effects*
  • Laparoscopy / methods
  • Male
  • Nephrectomy / adverse effects
  • Nephrectomy / methods*
  • Postoperative Complications / diagnosis
  • Postoperative Complications / surgery
  • Risk Assessment
  • Time Factors
  • Treatment Outcome