Role of multi-detector computed tomography (MDCT) in management of post percutaneous nephrolithotomy (PCNL) bleeding
Arvind P Ganpule1, Darshan H Shah1, Sanika A Ganpule2
1Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India.
Insights
Multidetector computerized tomography (MDCT) angiography accurately identifies bleeding after percutaneous nephrolithotomy (PCNL), matching conventional angiography (CA) findings. This noninvasive imaging aids in precise embolization for post-PCNL hemorrhage.
Area of Science:
- Urology
- Interventional Radiology
- Medical Imaging
Background:
- Post-percutaneous nephrolithotomy (PCNL) bleeding is a significant complication.
- Conventional angiography (CA) is invasive and carries risks.
- Accurate diagnosis of bleeding source is crucial for effective management.
Purpose of the Study:
- To evaluate multidetector computerized tomography (MDCT) angiography for diagnosing post-PCNL bleeding.
- To compare the diagnostic accuracy of MDCT angiography with CA.
- To assess the role of MDCT angiography in guiding embolization therapy.
Main Methods:
- Retrospective analysis of eight patients with post-PCNL bleeding.
- MDCT angiography performed using a 16-slice CT scanner.
- Comparison of MDCT angiography findings with subsequent CA in all patients.
Main Results:
- MDCT angiography and CA findings were concordant in all cases.
- Common post-PCNL bleeding sources included aneurysms and arteriovenous fistulas with pseudoaneurysms.
- MDCT angiography facilitated accurate assessment and embolization of bleeding arterial trees.
Conclusions:
- MDCT angiography is a rapid, reproducible, and noninvasive imaging modality.
- MDCT angiography accurately assesses the site and nature of bleeding after PCNL.
- MDCT angiography is a valuable tool for managing post-PCNL hemorrhage.
Objective:
To evaluate the role of multidetector computerized tomography (MDCT) angiography in post percutaneous nephrolithotomy (PCNL) bleed and compare findings with conventional angiography (CA).
Material And Methods:
We conducted a retrospective analysis of patients who had post PCNL bleeding and subsequently underwent a MDCT angiography followed by CA. We reviewed eight patients, who presented between January 2009 and January 2013. We performed a MDCT angiography on a 16 slice GE bright speed CT scanner. All angiographies were done by using the Digital Subtraction Angiography Suite. The angioembolisation, if required, was conducted by an interventional nephrologist, specializing in therapeutic embolisation.
Results:
The mean age of the patients was 42±17 years. Mean time of post PCNL bleed presentation was 10.06±7.9 days. Five patients presented with aneurysm and three presented with an AV fistula with pseudoaneurysm. The right renal unit was involved in six cases and the left in two cases. The lower polar segmental artery was involved in six cases and the upper polar artery in two cases. The CA and MDCT findings matched in all cases and the MDCT helped the clinician to assess and embolise the appropriate arterial tree.
Conclusion:
MDCT is rapid, reproducible and noninvasive. MDCT angiography performed in the setting of post PCNL bleeding provides an accurate assessment of the site and nature of bleeding. The MDCT angiography matched the CA findings in all patients in the present study.
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