A multiphase study is recommended, including non-contrast, arterial and subsequent portal venous phase approximately a minute after injection of a contrast bolus. The presence of a post-operative perinephric haematoma can be demonstrated by CT, ultrasound or MR imaging however, the site of active haemorrhage is best demonstrated on a CT angiography (CTA), or ultimately, diagnostic angiography (DSA) (Fig. Post-operative haemorrhage may arise from an unsecured artery, or days to weeks later due to the rupture of a pseudoaneurysm of an intrarenal artery (Fig. Two main complications following nephrectomy requiring CT imaging is haemorrhage and urinary leakage. For smaller lesions, nephron-sparing procedures such as partial nephrectomy or percutaneous therapies are increasingly favoured.Įarly CT imaging is indicated to assess the clinically suspected complications of surgery and to enable early management. Open and laparoscopic radical nephrectomy is the gold standard in the management of large renal masses. Nephrectomy and ablative therapy complications This could help the radiologist to prevent, as well as to diagnose, complications from renal interventions. Risk factors that are more commonly associated with complications will also be summarised. The aim of this article is to familiarise the radiologist with the common and less common complications from various renal interventions. These include renal procedures such as lithotripsy, radiological renal interventions such as image-guided core biopsies, as well as therapeutic interventions such as surgery, namely nephrectomy, and radiotherapy, whilst shown to have high rates of safety and efficacy, these interventions are also associated with some potential complications. Ī wide range of interventions form part of the diagnostic and therapeutic pathway of renal diseases. An analysis of the National Cancer Database, recognised as the largest cancer registry in the world, showed that the proportion of patients receiving partial nephrectomy has almost doubled over approximately 10 years, from approximately 36.4% in 2004 to 61.2% in 2015. The use of nephron-sparing interventions such as partial nephrectomy and ablative techniques is also increasingly favoured over radical nephrectomies. For example, a recent systematic review of data from six countries found that the use of extracorporeal shockwave lithotripsy and open surgery fell by 14.5% and 12%, respectively, whilst the use of ureteroscopy increased by more than 250% in the past two decades. In addition, the increased detection of smaller and, often asymptomatic, renal pathologies have also led to the adoption of more conservative management options and to a progressive increase in a variety of more targeted and less invasive interventions. For example, the rates of intervention performed for urinary calculi have increased by approximately 17% in the past 20 years. The increased incidence of renal pathologies has significantly increased the number of renal interventions undertaken to diagnose and to treat renal pathologies. Renal cell carcinoma makes up the majority (approximately 90%) of detected renal cancers and has been increasing in incidence worldwide, with an age-standardised incidence rate of up to 16.7 per 100,000. The prevalence of renal calculi is estimated to be as high as 10–13% worldwide, increasing with age. This has in part been attributed to the ubiquity of high-quality imaging such as ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI), leading to increased detection of smaller renal masses and of smaller renal calculi. The incidence of common renal pathologies such as renal calculi and renal cell carcinoma has continuously increased over the past 50 years.
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