Sometimes a medical treatment is still indicated with prolonged assumption of Etidronic Acid (16) and myorelaxing drugs. After surgery we recommend cold therapy in order to minimize swallow and post oper
Renal artery embolization (RAE), selleckchem Crizotinib firstly described in 1969 by Lalli AF and Peterson N, was above all indicated in the symptomatic treatment of the hematuria and in the palliation of metastatic renal cancer (1, 2). With technical advances and growing experience, the indications have broadened to include conditions such as vascular malformations, medical renal disease, angiomyolipomas and preoperative infarction. The introduction of smaller delivery catheters and more precise embolic agents has drastically improved the morbidity associated with this technique (3).

However, opinions on the role of preoperative RAE in the management of patients with renal clear cells carcinoma are controversial (4). Although a significant number of studies on RAE are reported in these patients, there is no consensus on the benefits and morbidity associated with the procedure (5, 6). Most proponents of preoperative RAE cite the facilitation of nephrectomy through decreased operative blood loss, ease of dissection secondary to oedema in tissue planes and decreased operative times (7). It is likely that RAE is underutilized perhaps because of a lack of prospective randomized studies demonstrating these potential benefits (8). The aim of this report is to demonstrate the utility of RAE in the dissection of gross renal neoplasms and in blood loss and operative times reduction.

Case report A 45-years-old female was admitted to our Surgical Unit because of fever, severe anaemia (Hb:7,6 g/dl), weight loss and macroscopic hematuria. The admission CT total body showed a gross neoplasm (about mm 87 �� 102) of the left kidney with intralesional vascularization associated to renal and paraortic lymphadenopathy (Fig. 1). The patient underwent to arteriography which showed an eteroplastic neoplasm and then to embolization of the distal branches of division of renal artery by metal coils (Fig. 2) such to allow surgical clamping and ligation during the subsequent nephrectomy without hindrance by metallic coils in the renal artery trunk (Fig. 3). Fig. 1 CT total body showing a gross neoplasm (about mm 87 �� 102) of the left kidney with intralesional vascularization, renal and paraortic lymphadenopathy.

Fig. 2 Embolization of the distal branches of division of left renal artery, performed 24 hours before nephroureterectomy. Fig. 3 Kidney clear cells carcinoma (pT2b, pN0, G3, Stage II according to AJCC 2010); the margins of the surgical resection and the lymphnodes removed were free. 24 hours later a left Anacetrapib nephroureterectomy was performed; however, the neoplasm was tightly sticking to the diaphragm so that it was required its removal en bloc with a small portion of this muscle. After paraortic lymphadenectomy, a drain in left renal space was inserted.