A rare complication in percutaneous nephrolithotomy: clinical case and implications

Area of Science:

• Urology
• Surgical Complications

Background:

• Percutaneous nephrolithotomy (PCNL) is the primary treatment for large kidney stones (>20 mm) due to its high single-session fragmentation rate.
• Bleeding is a known complication, with severe cases requiring intervention in 0.8% of PCNL procedures.

Observation:

• This case report details a rare complication of PCNL: severe bleeding and hemodynamic instability due to lumbar artery injury.
• The injury necessitated conversion to open surgery for hemostasis control via coagulation and ligation.

Findings:

• Successful management of a severed lumbar artery during PCNL was achieved through prompt surgical intervention.
• The patient stabilized and was discharged, with planned follow-up for ureteroscopic lithotripsy.

Implications:

• This case underscores the importance of thorough anatomical knowledge and surgical principles, particularly regarding the lateral lumbotomy approach, for PCNL procedures.
• Surgeons must be prepared for rare but severe complications like lumbar artery damage during PCNL.