Hemorrhagic complicationes after percutaneous nephrolithotomy: The importance of an early endovascular management

Roca, A. Alabat; Ortiz, Carlos Torrecilla; Campaña, José María Cuadrado; Freixas, S. Colom; Schwalb, J. Fernández-Concha; García, S. Beato; Rey, E. Alba; Guevara, Daniela; Julià, F. Vigués

doi:10.1016/j.acuroe.2021.10.002

Cited by 3 publications

(4 citation statements)

References 23 publications

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“…Another such scenario could involve the slow decline in the wounded vessel’s structural integrity. Alabat et al 8 indicated that the major cause of unsuccessful initial renal artery embolization is missed embolization of tiny pseudoaneurysms and undetected arteriovenous fistula. Another important issue is the return of blood flow in embolized arteries.…”

Section: Discussionmentioning

confidence: 99%

Experience of Multiple Super-Selective Renal Angiographic Embolization (SRAE) After Minimally-Percutaneous Nephrolithotomy Haemorrhage: A Case Report

Hu,

Wu,

Wang

et al. 2024

JIR

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Section: Discussionmentioning

confidence: 99%

Experience of Multiple Super-Selective Renal Angiographic Embolization (SRAE) After Minimally-Percutaneous Nephrolithotomy Haemorrhage: A Case Report

Hu,

Wu,

Wang

et al. 2024

JIR

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“…PA and AVF are the main causes of delayed bleeding. This patient had several pre- and intraoperative risk factors for developing hemorrhagic complications: diabetes, arterial hypertension, large stone size, multiple access tracts, and long operative duration [ 5 ]. Superselective angioembolization (SAE) is a safe and effective method to control post-PNL arterial bleeding [ 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Remarkable in our patient was the long time interval (28 days) between PNL and SAE. In a subgroup analysis by Alabat Roca et al concerning late hemorrhagic complications, the mean time from PNL to SAE in this subgroup was 10.5 days [ 5 ]. Although delayed bleeding after PNL is suggestive of a less intense nature, this case illustrates that the sudden onset of, for example, gross hematuria with clots at a certain time point is of more importance than the time interval with subsequent imaging (CTA and angiography) to diagnose intrarenal vascular lesions such as PA and AVF to decide to go for early SAE.…”

Section: Discussionmentioning

confidence: 99%

Renal Pseudoaneurysm with Associated Arteriovenous Fistula as a Cause of Delayed Bleeding after Percutaneous Nephrolithotomy: A Case Report and Current Literature Review

Devos

Vandeursen

d'Archambeau

et al. 2023

Case Reports in Urology

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Background. Pseudoaneurysm (PA) with associated arteriovenous fistula (AVF) is a rare delayed bleeding complication, occurring in less than 1% of patients after percutaneous nephrolithotomy (PNL). Case presentation. A 54-year-old man underwent PNL on February 28, 2023, for a large renal calculus in the right kidney lower pole, with postoperative delayed bleeding: macroscopic hematuria and bladder clot retention after 3 weeks. An iatrogenic PA and AVF were diagnosed after the failure of conservative measures. The patient was successfully treated with superselective angioembolization (SAE) under local anesthesia. Conclusion. Late hemorrhagic complications after PNL can be severe. Rapid identification of a renal PA and AVF with SAE has a high success rate and low complication rate, avoiding prolonged hospitalization time and major renal surgery for this patient.

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“…The choice of the protocol also influences the efficacy and complications. Alabat Roca et al [18] reported that 1,335 PCNL procedures were performed, and a total of 59 (4.4%) patients had hemorrhagic complications. The probability of excessive bleeding in the multi-tract PCNL procedure was 2.77 times higher than that of the single-tract procedure [19].…”

Section: Discussion/conclusionmentioning

confidence: 99%

One-Stage Flexible Ureteroscopy during Single-Tract Percutaneous Nephrolithotomy in the Treatment of Parallel Calyceal Stones

Zhu

Chen

et al. 2022

Urol Int

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Introduction: The aim of this study was to compare the clinical safety and efficiency between one-stage flexible ureteroscopy (FURS) during single-tract percutaneous nephrolithotomy (PCNL) and multi-tract PCNL in the treatment of parallel calyceal stones. Methods: One hundred and twenty-five patients who had calyceal stones parallel to puncture channel from March 2017 to January 2021 were enrolled and assigned into two groups. Seventy cases received the treatment of FURS combined with single-tract PCNL under the oblique supine position (the Combined group), and 55 cases had multi-tract PCNL procedure under the prone position (the Multi-tract group). Demographic characteristics, clinical information, and surgical outcomes were analyzed. Results: Demographic variables and stone characteristics did not show statistical difference between the two groups. Compared with the Multi-tract group, there were longer operation time (p = 0.021), shorter postoperative hospitalization days (p = 0.003), smaller postoperative hemoglobin drop (p = 0.002), less incidence of moderate and severe postoperative pain (p = 0.001), and postoperative perirenal hematoma (p = 0.012) in the Combined group. No significant difference was found in the stone-free rate (SFR) and postoperative fever between the two groups (p = 0.880 and p = 0.324). More patients needed postoperative intervening embolization in the Multi-tract group (p = 0.048). Discussion/Conclusions: For most patients with parallel calyceal stones, one-stage FURS combined with single-tract PCNL procedure was a safer procedure for the reduction of complications and could achieve a comparative SFR compared to the multi-tract PCNL.

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Hemorrhagic complicationes after percutaneous nephrolithotomy: The importance of an early endovascular management

Cited by 3 publications

References 23 publications

Experience of Multiple Super-Selective Renal Angiographic Embolization (SRAE) After Minimally-Percutaneous Nephrolithotomy Haemorrhage: A Case Report

Experience of Multiple Super-Selective Renal Angiographic Embolization (SRAE) After Minimally-Percutaneous Nephrolithotomy Haemorrhage: A Case Report

Renal Pseudoaneurysm with Associated Arteriovenous Fistula as a Cause of Delayed Bleeding after Percutaneous Nephrolithotomy: A Case Report and Current Literature Review

One-Stage Flexible Ureteroscopy during Single-Tract Percutaneous Nephrolithotomy in the Treatment of Parallel Calyceal Stones

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