Testicular Infarction, a Complication of Preoperative Renal Embolization with Embospheres and Gelfoam: A Case Report

Background: Renal artery embolization (RAE) has a wide range of indications including preoperative embolization of renal cell carcinomas and treatment of benign renal tumors for potential hemorrhagic complications. RAE is considered generally safe and effective, however it is not without potentially serious complications. We present a case of right testicular infarction following right renal embolization for a renal cancer using Embospheres and Gelfoam. Case Report: A 59-year-old male with large right renal cell carcinoma invading the renal vein, underwent preoperative right renal artery embolization using embospheres and gelfoam to decrease intraoperative hemorrhage and the need for post-operative transfusion. During the procedure a small uretral artery was seen arising from the distal right renal artery. Following the procedure the patient underwent right nephrectomy with minimal bleeding intraoperatively and estimated blood loss of less than 200 ml. On postoperative day 2, the patient developed right testicular pain and swelling. Physical examination showed mild right scrotal swelling and skin edema. Scrotal ultrasound showed heterogenous right testicle with decreased vascularity and absent arterial waveforms, although some venous waveforms were demonstrated. Small to moderate right hydrocele with debris. The patient was managed conservatively, with progressive improvement. On follow-up the patient reported resolution of the symptoms and scrotal ultrasound showed interval improvement in the right testicle vascularity with demonstration of both venous and arterial waveforms. Conclusions: Small renal arterial branches and connections are potential route for non-target embolization during renal artery embolization, leading to potentially serious complications including testicular infarction.

 

Scroll to top

Publication History

Article published online:
26 April 2021