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Delayed postpercutaneous nephrolithotomy hemorrhage: prevalence, predictive factors and management.
Akbar Nouralizadeh1, Seyed Amir Mohsen Ziaee, Seyed Hossein Hosseini Sharifi
1Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences (SBMU) , Tehran, IR , Iran.
Scandinavian Journal of Urology
|November 22, 2013
Summary
Delayed bleeding after percutaneous nephrolithotomy (PCNL) is uncommon. Conservative management is often effective, though tubeless PCNL may increase bleeding risk.
Area of Science:
- Urology
- Nephrology
- Surgical Complications
Background:
- Delayed bleeding is a recognized complication following percutaneous nephrolithotomy (PCNL).
- Understanding risk factors and effective management strategies is crucial for patient outcomes.
Purpose of the Study:
- To determine the prevalence and identify risk factors for delayed bleeding after PCNL.
- To evaluate the management strategies, including conservative care and angioembolization.
Main Methods:
- Retrospective review of 2304 patients undergoing PCNL between 2008 and 2011.
- Analysis of variables including patient demographics, stone characteristics, surgical approach, and drainage type.
- Assessment of conservative management and angioembolization efficacy.
Main Results:
- Delayed hemorrhage occurred in 2.6% of patients, with a mean onset of 5.8 days post-PCNL.
- Tubeless PCNL was significantly associated with an increased rate of postoperative bleeding.
- Most cases were managed conservatively; few required angiography or embolization.
Conclusions:
- Delayed bleeding post-PCNL is infrequent and typically manageable conservatively.
- Tubeless PCNL is a significant predictor of severe postoperative bleeding.
- Angiography and embolization are reserved for refractory cases.
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