Office-Based Renal Tumor Biopsy: a Paradigm Change in the Management of a Small Renal Mass?

Clinical outcomes after emergency transarterial renal embolization: a retrospective study

BACKGROUND

Studies on emergency transarterial embolization (TAE) of renal arterial injuries are rare. The aim of this retrospective study was to evaluate clinical outcomes after emergency transarterial renal embolization.

MATERIAL AND METHODS

Between January 1st, 2013 and January 1st, 2024, all consecutive patients treated for renal arterial injuries by TAE in emergency settings were retrospectively reviewed. Demographic, biological and angiographic data were recorded. The inclusion criteria were all patients ≥ 18-years-old treated by emergency TAE for renal vascular injury. Clinical success was defined as the resolution of bleeding signs without the need for repeat TAE, surgery, death related to massive blood loss during this period, without functional impairment (> 50% of parenchyma volume or onset of chronic kidney disease) following TAE.

RESULTS

During the inclusion period, 79 procedures were performed. The median age was 60[39-73] years old. On preoperative CT, ≥ 1 pseudoaneurysm was detected in 36(45.6%) patients, and active bleeding in 47(65.8%) patients. The preoperative median haemoglobin rate was 8.9[7.6-11] g/dl, and 37(46.8%) patients required red blood cell transfusions. The main aetiologies of arterial injury were blunt trauma (n = 19) and renal biopsy (n = 17). No severe adverse events were reported. Clinical success was reported in 74(93.7%) of the procedures. Three (3.8%) repeat embolizations were required, and were clinically successful. During the median follow-up of 7[1.5-35.5] months, 9(11.4%) patients died, of which 5(6.3%) occurred within 30 days.

CONCLUSION

The present study reports high clinical success, low complications and low rebleeding rates of emergency renal TAE.

Ultrasound-Guided Renal Mass Biopsy and Its Clinical Utility: A Single-Centre Experience

INTRODUCTION

Renal mass biopsy (RMB) is still underutilized, partially because many urologists argue that it does not substantially influence the management of renal masses. We sought to evaluate the influence of RMB on the management of renal tumours in our institution.

MATERIALS AND METHODS

A total of 387 RMBs performed at our institution from January 2016 to June 2020 were included. Patient demographics, mass size, biopsy result, and subsequent clinical management were retrospectively reviewed.

RESULTS

The mean mass size was 47.8 mm. Fifty-six percentage of tumours ≤40 mm (247) and 8% of tumours >40 mm (64) were biopsied. Seventy-six RMBs of disseminated tumours were performed. 14.9% of RMBs were non-diagnostic, and 27.1% of RMBs of tumours ≤40 mm were benign. The majority of tumours with first non-diagnostic RMB followed by histopathological verification were found to be malignant. There was significantly more conservative management and no radical nephrectomies in the benign biopsy group. One case of Clavien-Dindo grade ≥2 complication occurred.

CONCLUSIONS

RMB result affects treatment decisions. Ultrasound-guided RMB is a safe procedure, and performing biopsies of tumours ≤40 mm may reduce the number of unnecessary interventions. Non-diagnostic RMBs should be repeated or treated as malignant.