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[Hemorrhagic complications during percutaneous nephrolithotomy. Retrospective studies of 772 cases]
E Gremmo1, P Ballanger, B Doré
1Service d'Urologie, CHU de Bordeaux, France.
Insights
Severe hemorrhage after percutaneous nephrolithotomy (PCNL) is rare but unpredictable. Selective embolization is the preferred treatment for controlling bleeding complications from PCNL.
Area of Science:
- Urology
- Nephrology
- Interventional Radiology
Background:
- Percutaneous nephrolithotomy (PCNL) is a common procedure for kidney stone removal.
- Hemorrhage is a potential complication of PCNL.
- Identifying risk factors and effective management strategies for PCNL-related hemorrhage is crucial.
Purpose of the Study:
- To evaluate the incidence and characteristics of severe hemorrhagic complications following PCNL.
- To analyze the management strategies employed for these complications.
- To identify any predisposing factors for severe bleeding after PCNL.
Main Methods:
- A retrospective analysis of 772 PCNL cases was conducted.
- Patients experiencing severe hemorrhage requiring hemostasis were identified (2.3% incidence).
- Management included nephrectomy, renal arteriography with embolization, or observation.
Main Results:
- Eighteen patients (2.3%) developed severe hemorrhage, with a mean onset of 18 days post-procedure.
- Renal arteriography revealed vascular abnormalities in 13 of 15 patients, including arteriovenous fistulas, false aneurysms, and arteriolar injuries.
- Highly selective embolization successfully treated 13 patients; 2 had spontaneous resolution. No risk factors were identified.
- Three nephrectomies were performed early in the experience.
Conclusions:
- Severe hemorrhage is a rare and unpredictable complication of PCNL.
- Selective embolization is an effective treatment for controlling PCNL-related bleeding.
- Further research may be needed to identify predictive factors for hemorrhage.
Objectives:
To evaluate the haemorrhagic complications of PCNL, to analyse their management and to identify predisposing factors.
Material And Methods:
Out of a series of 772 cases of PCNL, 18 patients developed severe haemorrhage requiring a haemostatis procedure (2.3%): 13 males and 5 females with a mean age of 57 years (38-79), and one case on a solitary kidney. The mean time to onset of haemorrhage was 18 days (--48 days).
Results:
Three nephrectomies for haemostatis were performed at the beginning of our experience. Renal arteriography was performed in 15 patients and was abnormal in 13 patients, showing 3 arteriovenous fistulas, 8 false aneurysms, 3 arteriolar injuries. All these vascular abnormalities were successfully treated by highly selective embolization. In 2 cases, arteriography was normal with a spontaneously favourable course. Comparison of the 2 groups of PCNL, with haemorrhage versus without haemorrhage, failed to demonstrate any risk factors.
Conclusion:
Severe haemorrhage following PCNL is a rare complication, but impossible to predict. Selective embolization allows control of bleeding and currently constitutes the treatment of choice.