Spontaneous subcapsular or perirenal haemorrhage caused by renal tumours. A urological emergency.

OBJECTIVE: Spontaneous perirenal haemorrhage is a rare abdominal emergency most commonly caused by solid renal tumours. The aim of this study was to evaluate the efficacy of different diagnostic methods and treatment modalities. MATERIAL AND METHODS: A total of 9 patients (5 women and 4 men) with spontaneous subcapsular or perirenal haemorrhage caused by renal tumours were treated at two Finnish central hospitals over a period of 20 years. RESULTS AND CONCLUSIONS: All the patients presented with flank pain, often severe and associated with a palpable mass and a reduced haemoglobin concentration. Ultrasonography was abnormal in all cases where it was used, but was able to show the tumour and haemorrhage correctly in only one case (13%). Computed tomography had a sensitivity of 71%. Seven patients underwent extrafascial nephrectomy (5 renal cell cancers, 1 malignant oncocytoma and 1 angiomyolipoma) and two with known tuberous sclerosis and bilateral renal angiomyolipomas were treated by superselective embolization. As these few cases were all individual and were collected over a long period of time, general statements about diagnosis and treatment must be approached critically. It may be concluded, however, that spontaneous perirenal haemorrhage is often a surgical emergency necessitating great efforts in terms of diagnosis and treatment. Computed tomography should be performed on all patients nowadays. If the bleeding is caused by a malignant tumour, extrafascial nephrectomy is the treatment of choice. For those with benign tumours selective embolization should be used.

Comparison of early deflation rate of detachable latex and silicone balloons and observations on persistent varicocele.

PURPOSE: To determine the frequency of and time until spontaneous deflation of detachable embolization balloons made of different materials and the correlation between persisting or recurrent varicocele and the spontaneous deflation of the balloons. MATERIALS AND METHODS: Forty-five patients with clinically detected left-sided varicocele underwent embolization with 78 silicone and 22 latex balloons. The minimum follow-up time was 3 months and the follow-up consisted of clinical examination, color duplex ultrasonography, and plain radiography of the balloons. Those patients who were suspected of having recurrent varicoceles underwent control venography to assess the internal spermatic vein. RESULTS: All of the latex balloons and 10% of the silicone balloons deflated spontaneously during the follow-up. The average time until deflation was 5.1 months for latex and 9.9 months for silicone balloons. Persistence of varicocele, attributed to perfusion through a previously occluded portion of the internal spermatic vein, occurred in two of 11 (18%) recurrences. Nine of 11 (72%) recurrences were due to bypassing collaterals past the site of detachable balloon placement. CONCLUSIONS: Latex balloons seem to predispose more to persisting/recurrent varicocele than silicone balloons. Early deflation of the balloons explained two (18%) of the 11 persisting or recurrent varicoceles. A combination of a sclerosing agent with balloon embolization of the internal spermatic vein is recommended.