Treatment of a hemorrhage secondary to nephrostomy tube placement for derivation of monstrous hydronephrosis in upper tract urothelial carcinoma

A 85-year-old female patient underwent nephrostomy tube insertion for a huge hydronephrosis due to a papillary mass involving the right ureteral ostium diagnosed by at computed tomography scan. As soon as the nephrostomy tube was inserted, a pulsatile bleeding was found and a renal angiography was done. A massive bleeding from the main and unique right renal artery was found such as to require prompt endovascular embolization. A transurethral resection of the bladder was performed and the pathology report confirmed high-grade pTa transitional cell carcinoma. An open drainage was then placed to empty the contents of the pyelocalyceal system of the kidney. Once obtained the volumetric reduction of the abdominal mass the patient underwent the right nephroureterectomy.