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Vascular complications after percutaneous nephrolithotomy: 10 years of experience
Marawan M El Tayeb1, John J Knoedler2, Amy E Krambeck2
1Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
Insights
Vascular complications after percutaneous nephrolithotomy (PNL) are rare, occurring in 0.48% of cases. Early superselective embolization (SSE) effectively managed bleeding, avoiding transfusions in many patients.
Area of Science:
- Urology
- Nephrology
- Vascular Surgery
Background:
- Percutaneous nephrolithotomy (PNL) is a common procedure for kidney stone removal.
- Vascular complications, though infrequent, can be serious after PNL.
Purpose of the Study:
- To evaluate the incidence and characteristics of vascular complications following PNL.
- To assess the effectiveness of superselective embolization (SSE) in managing PNL-related bleeding.
Main Methods:
- Retrospective review of 3338 PNL procedures performed by urologists using fluoroscopic guidance.
- Analysis of patients who required renal angiography and SSE for significant bleeding.
- Comparison of demographic, operative, and stone characteristics between complication and uneventful groups.
Main Results:
- The incidence of significant vascular bleeding requiring SSE was 0.48% (16 renal units).
- Mean time to bleeding was 7 days and to SSE was 9.6 days.
- Vascular complications group had a lower stone burden (>2 cm) compared to the uneventful group (43.7% vs 74.03%).
Conclusions:
- The incidence of vascular complications in this contemporary PNL series is notably low.
- Vascular bleeding after PNL appears to be a rare and random event, with no specific risk factors identified.
- Early SSE is effective in managing PNL-related vascular bleeding and can prevent the need for blood transfusion.
Objective:
To provide a contemporary look at vascular complications after percutaneous nephrolithotomy (PNL) with access performed solely by a urologist using fluoroscopic guidance.
Methods:
A retrospective review of 2792 patients who had 3338 PNLs at Indiana University Health Methodist Hospital and Mayo Clinic Rochester was performed. Patients who experienced significant bleeding requiring diagnostic renal angiography and superselective embolization (SSE) were reviewed and compared with the overall database.
Results:
There were 15 patients (16 renal units) requiring renal angiography and SSE (0.48%). Mean time from PNL to bleeding was 7 days (range, 1-15 days) and to SSE was 9.6 days (range, 2-18 days). Mean drop in hemoglobin was 5.3 g/dL (range, 2-9 g/dL). Transfusion was needed in 9 patients (60%). There were no differences between the vascular complications group and the uneventful PNL group in mean age (55.06 vs 52.2 years; P = .519), UTI history (40% vs 38%; P = .92), mean operative time (125.8 vs 102.47 minutes; P = .192), the need for multiple access (18.75% vs 18%; P = .939), and access location. The vascular complications group had a lower stone burden than the uneventful PNL group (stones > 2 cm; 43.7% vs 74.03%; P = .014).
Conclusion:
The incidence of vascular complications in this contemporary series is one of the lowest reported to date. At our centers, vascular bleeding complications appear to be a random and rare event after PNL as we were unable to identify any specific risk factors. Early SSE avoided the need for blood transfusion in many patients.
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