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Risk factors for hemorrhage requiring embolization after percutaneous nephrolithotomy
Sitki Un1, Volkan Cakir2, Cengiz Kara1
1Department of Urology, Izmir Katip Çelebi University, Ataturk Education and Research Hospital, Izmir, Turkey;
Insights
Percutaneous nephrolithotomy (PCNL) can lead to serious bleeding complications. Angiography and embolization are crucial for managing severe hemorrhages, with renal abnormalities and stone size predicting the need for intervention.
Area of Science:
- Urology
- Interventional Radiology
Background:
- Percutaneous nephrolithotomy (PCNL) is a common kidney stone treatment with significant complication rates.
- Arteriovenous fistulas from severe hemorrhage are a serious post-PCNL complication.
Purpose of the Study:
- To review data of patients who required angiography and embolization for post-PCNL hemorrhage.
- Identify predictors for the need for angiography and embolization after PCNL.
Main Methods:
- Retrospective review of 1405 patients undergoing PCNL between 2007 and 2014.
- Patients with hemorrhage underwent angiography and embolization if a bleeding focus was identified.
Main Results:
- 10.4% of patients (147) required transfusion for post-PCNL hemorrhage.
- 14 patients (0.99%) underwent angiography and embolization; 133 were managed conservatively.
- Renal abnormalities and larger stone size were significant predictors for requiring angiography and embolization (p < 0.001).
Conclusions:
- Close hemodynamic monitoring is essential for patients with significant post-PCNL hematuria.
- Angiography should be considered for persistent bleeding requiring transfusion.
Introduction:
Percutaneous nephrolithotomy (PCNL) is the primary surgical intervention in kidney stone management. Even though it is performed quite often, the complication rates are also high. Arteriovenous fistulas following extended hemorrhages after PCNL are one of the most serious complications of this operation. Our main objective was to review the data of patients who required angiography and embolization.
Methods:
In total, we included 1405 patients who underwent PCNL between 2007 and 2014. All patient data were retrospectively reviewed. All patients went under PCNL using fluoroscopy. Following informed consent, all hemorrhagic patients underwent angiography in the interventional radiology department and embolization was performed in patients with a hemorrhage focus point.
Results:
A total of 147 patients (10.4%) required transfusion for post-PCNL hemorrhages. Of them, 14 (0.99%) underwent angiography and embolization (9 [64.2%] were male and 5 [35.8%] were female, with a mean age of 39.4 ± 10.2). The remaining 133 patients were conservatively managed (81 [60.9%] males and 52 [39.1%] females, with a mean age of 42.3 ± 12.4). When the predicting factors for angiography and embolization were reviewed, renal abnormalities and the mean size of stones were significant in both univariate and multivariate analysis (p < 0.001).
Conclusion:
Patients with extended and intermittent hematuria should be monitored closely for hemodynamics; if there is an ongoing necessity for transfusion, angiography should be considered.
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