A rare complication in percutaneous nephrolithotomy: clinical case and implications

Percutaneous nephrolithotomy has become the standard procedure for the management of large kidney stones. Compared with other endo-urological techniques, it has a better fragmentation rate in a single session for kidney stones over 20 mm. It is therefore the recommended first-line treatment modality for large kidney stones. Bleeding is a well-known complication of this procedure, often requiring transfusion. In 0.8% of cases, bleeding can be severe, requiring surgical intervention to control hemostasis. Damage to the lumbar artery is a very rare event, and a potential complication. To our knowledge, this is the first report of lumbar artery involvement during percutaneous nephrolithotomy, complicated by severe bleeding and hemodynamic instability, necessitating conversion. Surgical exploration revealed a severed and bleeding lumbar artery. After hemostasis control by coagulation and ligation, the patient became stable. The patient was discharged on D3, where ureteroscopic lithotripsy was planned after collegial discussion with the patient. Based on this experience, it is important for the surgeon to have in mind certain principles and a thorough knowledge of the classic lateral lumbotomy approach to the kidney.