Abstract
PURPOSE: To determine the incidence of renal artery pseudoaneurysm (RAP) after robotic-assisted partial nephrectomy (RaPN), identify predictive factors, and evaluate endovascular management. METHODS: The institutional RaPN database was retrospectively reviewed, and data from December 2009 to June 2021 were used. Computed tomography angiography was used to diagnose RAP. Patients who underwent embolization for RAP after RaPN were compared with those without RAP or with RAP managed conservatively. Data on patient demographics, tumor characteristics, and operative outcomes were evaluated, and the predictive factors for RAP after RaPN were determined. RESULTS: Of the 544 patients who underwent RaPN, 14 developed RAP after surgery, of which 12 underwent embolization. Most patients experienced gross hematuria and were diagnosed using computed tomography angiography. No patient exhibited recurrent RAP during follow-up. The following was found for patients who underwent embolization for RAP: a higher proportion of men (91.7% vs. 59.4%, p = 0.024), higher RENAL nephrometry scores (median: 9.0 vs. 8.0, p = 0.02), longer operative times (mean: 349.6 vs. 283.7 min, p = 0.046), and longer postoperative hospital stays (median: 6.0 vs. 5.0 days, p = 0.031). The N score in the RENAL nephrometry score was significantly higher in the embolization group (p = 0.031) than in the nonembolization group. Univariate analysis revealed that RENAL nephrometry scores and total operative time were significant predictors of RAP occurrence. CONCLUSION: The occurrence of RAP was associated with higher RENAL nephrometry scores and longer operative times.