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Postpercutaneous nephrolithotomy bleeding: aetiology and management.

Arvind P Ganpule1, Darshan H Shah, Mahesh R Desai

  • 1Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.

Current Opinion in Urology
|January 22, 2014
PubMed
Summary
This summary is machine-generated.

Postpercutaneous nephrolithotomy (PCNL) bleeding is a serious complication. Superselective angioembolization (SAE) effectively controls bleeding in over 80% of cases, though multiple punctures increase failure risk.

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Area of Science:

  • Urology
  • Interventional Radiology

Background:

  • Postpercutaneous nephrolithotomy (PCNL) bleeding is a significant and feared complication.
  • Identifying risk factors and management strategies is crucial for patient outcomes.

Purpose of the Study:

  • To review risk factors associated with post-PCNL bleeding.
  • To outline criteria for managing post-PCNL bleeding.
  • To discuss the treatment algorithm for this complication.

Main Methods:

  • Review of literature on post-PCNL bleeding.
  • Analysis of risk factors and management strategies.
  • Discussion of treatment algorithms and interventional techniques.

Main Results:

  • A perfect initial puncture is key to preventing bleeding.
  • Superselective angioembolization (SAE) is effective (>80% success rate) for controlling post-PCNL bleeding.
  • Pseudoaneurysm is the most common finding; multiple punctures, >2 bleeding sites, and gelatine sponge alone are risk factors for SAE failure.

Conclusions:

  • Post-PCNL bleeding is life-threatening but often manageable conservatively.
  • SAE is an effective treatment for persistent bleeding.
  • Skilled interventionists can achieve successful hemostasis; multiple punctures and >2 lesions predict higher failure risk.