Pitfall of Renal Vascular Embolization in Managing Recurrent Hematuria Post-Nephrolithotomy: A Case Report

Renal vascular embolization (RVE) is an advanced, minimally invasive procedure frequently employed in the clinical management of recurrent haematuria, particularly in patients with underlying vascular abnormalities contributing to this condition. Although renal vascular embolization (RVE) has demonstrated considerable efficacy in mitigating the symptoms associated with haematuria, it can pose substantial challenges.

The case report shows a patient with a history of nephrolithiasis who underwent open nephrolithotomy for a right renal calculus. After the procedure, the patient developed haematuria and underwent renal vascular embolization. Three weeks post-procedure, the patient returned with severe haematuria and the second renal vascular embolization procedure was performed. The condition indicates undetected vascular abnormalities during the procedure, which resulted in an incomplete embolization. This comprehensive analysis of the case report underscores the critical importance of conducting thorough pre-procedural imaging, ensuring precise catheter placement throughout the intervention, and the urgent need to identify all pertinent vascular structures that may relate to the patient's condition. Furthermore, this case illustrates the potential implications of overlooking anatomical variations in the renal vasculature, which can adversely affect treatment efficacy and patient recovery.

Pre-embolization CT angiography is essential in managing recurrent hematuria following nephrolithotomy to identify all potential sources of hemorrhage and all feeding vessels, including accessory arteries. Selective angiography may further enhance the accuracy of vascular mapping.