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Management of Bleeding Complications after Percutaneous Nephrolithotripsy: A Single-Center Experience
Shang Xu1, Tianwei Zhang1, Yuxia Lin1
1Department of Urology, The Affiliated Hospital of Qingdao University, 266000 Qingdao, Shandong, China.
Insights
Severe bleeding after percutaneous nephrolithotripsy (PCNL) requires careful management. Conservative treatment and embolization are effective, but treatment decisions should consider clinical factors, not just hemoglobin levels.
Area of Science:
- Urology
- Nephrology
- Interventional Radiology
Background:
- Hemorrhage is a significant complication following percutaneous nephrolithotripsy (PCNL).
- Effective management strategies for post-PCNL bleeding are crucial for patient outcomes.
Purpose of the Study:
- To analyze the management experience of severe bleeding complications after PCNL.
- To evaluate the effectiveness of different treatment modalities for post-PCNL hemorrhage.
Main Methods:
- Retrospective analysis of 77 patients with severe bleeding post-PCNL.
- Categorization into conservative treatment (40 patients), transfusion (13 patients), and embolization (24 patients) groups.
- Analysis of hemoglobin/hematocrit changes, bleeding causes, management, and clinical results.
Main Results:
- Conservative treatment showed a mean hemoglobin decrease of 33.8 g/L.
- Transfusion group had a mean hemoglobin decrease of 49 g/L and longer hemorrhage time.
- Renal artery embolization (RAE) group experienced a mean hemoglobin decrease of 52.8 g/L; a hematocrit drop of ≥14.65% indicated RAE necessity.
Conclusions:
- Decreased hemoglobin can guide embolization decisions but isn't absolute.
- Both conservative management and embolization are effective hemostatic strategies.
- Treatment selection requires comprehensive assessment of clinical signs, bleeding triggers, and blood indices.
Background:
Hemorrhage is the most common and dangerous complication after percutaneous nephrolithotripsy (PCNL). Therefore, this study introduces the management experience of bleeding complications in our center.
Methods:
This retrospective study included 77 patients with severe bleeding after PCNL. Forty patients were included in the conservative group, 13 in the transfusion group, and 24 in the embolization group. The characteristics of postoperative bleeding were analyzed, including changes in hemoglobin and hematocrit, bleeding inducement, bleeding management, and clinical results.
Results:
Forty patients received conservative treatment. Their mean hemorrhage time was 6.5 days (range, 3-14 days), and their mean decreased hemoglobin was 33.8 g/L (range, 13-61 g/L). Thirteen patients received only conservative treatment and blood transfusions. Their mean hemorrhage time was 11 days (range, 2-17 days), and their mean decreased hemoglobin was 49 g/L (range, 25-85 g/L). Twenty-four patients required renal angiography and renal artery embolization (RAE). Their average time from PCNL to RAE was 11 days (range, 3-25 days). Hemoglobin levels decreased by an average of 52.8 g/L (range, 19-89 g/L). A decrease in hematocrit ≥14.65% was a significant indicator for post-PCNL RAE.
Conclusions:
A decreased hemoglobin level can be used as a reference for decisions regarding embolization; However, it should not be used as an absolute criterion. Conservative treatment and embolization are effective for achieving hemostasis. Appropriate treatment methods should be comprehensively determined based on clinical manifestations, bleeding inducement, and blood index changes.
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