Critical causes in severe bleeding requiring angioembolization after percutaneous nephrolithotomy

Area of Science:

• Urology
• Nephrology
• Surgical Outcomes

Background:

• Severe bleeding is a complication of percutaneous nephrolithotomy (PCNL).
• Angioembolization is used to manage severe bleeding post-PCNL.
• Anatomically incorrect renal puncture is a suspected risk factor.

Purpose of the Study:

• To identify risk factors for severe bleeding requiring angioembolization after PCNL.
• To investigate the role of anatomically incorrect renal puncture in post-PCNL bleeding.

Main Methods:

• Retrospective review of 53 patients undergoing PCNL with postoperative CT scans.
• Comparison of patient, stone, and procedural factors between angioembolized and non-angioembolized groups.
• Evaluation of puncture correctness based on postoperative CT scans and defined anatomical criteria (within 20 degrees of Brödel's line).

Main Results:

• Incorrect renal puncture was significantly more common in patients who underwent angioembolization (66.7%) compared to those who did not (34.4%, p=0.021).
• Multivariable regression identified puncture correctness as the sole significant factor (OR 3.818, p=0.024).

Conclusions:

• Anatomically incorrect renal puncture is a significant risk factor for severe bleeding requiring angioembolization after PCNL.
• Emphasizes the critical importance of adhering to fundamental principles of renal puncture during PCNL procedures.