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Incidence and management outcomes of vascular complications after percutaneous nephrolithotomy: a systematic review

Lester Anthony H Florencio1, Jose Vicente T Prodigalidad2

  • 1Department of Urology, Section of Minimally Invasive Surgery and Endourology, National Kidney and Transplant Institute, Quezon City, Philippines. lester.florencio@gmail.com.

International Urology and Nephrology
|January 14, 2026
PubMed

Insights

Vascular complications after percutaneous nephrolithotomy (PCNL) are uncommon but significant. Pseudoaneurysms are most frequent, with angioembolization showing high success rates for management.

Area of Science:

  • Urology
  • Interventional Radiology
  • Nephrology

Background:

  • Vascular complications following percutaneous nephrolithotomy (PCNL) can cause significant morbidity.
  • This systematic review and meta-analysis examines contemporary data on these complications.

Purpose of the Study:

  • To evaluate the incidence, distribution, and management outcomes of vascular complications after PCNL.
  • To assess the effectiveness of different treatment modalities.

Main Methods:

  • Systematic search of multiple databases (PubMed/MEDLINE, EMBASE, BIOSIS, Google Scholar, Cochrane Library) for observational studies (2015-2025).
  • Pooled proportions calculated using a random-effects model; heterogeneity assessed with I² statistic.
  • Methodological quality evaluated using the Newcastle-Ottawa Scale.

Main Results:

  • Pooled incidence of vascular complications was 3% (95% CI 2-4%) across 10,440 PCNL procedures.
  • Pseudoaneurysms (57%) were the most common lesion, followed by arteriovenous fistulas (29%).
  • Angioembolization success rate was 92%, significantly higher than conservative management (67%) (p=0.0013).

Conclusions:

  • Vascular complications post-PCNL are infrequent but clinically relevant.
  • Pseudoaneurysm is the predominant lesion; angioembolization is highly effective.
  • Conservative management is viable for selected cases; findings should consider study heterogeneity.
Abstract

Keywords:
AngioembolizationArteriovenous fistulaEndourologyHemorrhagePercutaneous nephrolithotomyPseudoaneurysmVascular complications

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