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Tract Location Predicts Angiographic Outcomes in Severe Post-Percutaneous Nephrolithotomy Bleeding: A Multicenter
Rong Cong1,2, Liang Qi3, Xiang Zhou1
1Department of Urology, First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
Journal of Endourology
|August 4, 2026
Summary
Nonpapillary tract location is a key predictor of severe bleeding after percutaneous nephrolithotomy (PCNL) requiring embolization. Documenting tract site during PCNL can improve decision-making for renal arteriography (RA).
Area of Science:
- Urology
- Interventional Radiology
- Nephrology
Background:
- Severe bleeding after percutaneous nephrolithotomy (PCNL) is a rare but serious complication.
- Identifying predictors for renal arteriography (RA) in severe post-PCNL bleeding is crucial for patient management.
Purpose of the Study:
- To identify predictors of angiographic outcomes in severe post-PCNL bleeding.
- To optimize clinical decision-making for performing RA after PCNL.
Main Methods:
- Retrospective analysis of 75 patients with severe post-PCNL bleeding.
- Severe bleeding defined by hemodynamic instability, hemoglobin drop >35 g/L, or persistent hematuria.
- Logistic regression and ROC analysis to identify predictors of transcatheter arterial embolization (TAE).
Main Results:
- Tract location was the sole independent predictor of embolization (p < 0.001).
- Nonpapillary tracts were significantly more frequent in patients requiring TAE (69.3%).
- ROC analysis showed good discrimination for predicting TAE (AUC = 0.778).
Conclusions:
- Nonpapillary tract location independently predicts the need for angiography and embolization in severe post-PCNL bleeding.
- Intraoperative documentation of tract site can enhance RA utility and expedite hemostasis.