Post-Percutaneous Nephrolithotomy Septic Shock and Severe Hemorrhage: A Study of Risk Factors

Abstract

Objective: To identify the risk factors predicting septic shock and severe hemorrhage in percutaneous nephrolithotomy (PCNL). Methods: We retrospectively analyzed 420 renal calculi patients who underwent ultrasound-guided PCNL from March 2005 to May 2011. Data on patients who experienced infectious shock requiring anti-shock therapy and severe renal bleeding requiring angiographic renal embolization or nephrectomy were compared with other patients using univariate analyses. Results: Of 420 patients, 10 (2.4%) suffered septic shock and 4 (1%) had severe hemorrhage. The two significant risk factors for infectious shock were preoperative urine white blood cell count and operation time. For severe bleeding the absence of hydronephrosis and puncture time were significant risk factors. Operation time >90 min was associated with both septic shock and severe renal bleeding (p = 0.017). In contrast, the risk of encountering severe renal bleeding was higher if a nephroscope rather than a ureteroscope was used (p = 0.045). Conclusions: Operation time was a risk factor for both septic shock and severe hemorrhage. The patients without hydronephrosis before operation were more likely to suffer severe renal bleeding. Reducing intraoperative puncture time can reduce the probability of severe post-PCNL hemorrhage. The use of a comparatively gross nephroscope passage was likely to result in severe renal bleeding.

Is standard percutaneous nephrolithotomy still the standard treatment modality for renal stones less than three centimeters?

“…[18] Urinary tract infections also prevent blood clot formation and facilitate bleeding. [19] In our study, none of the preoperative and intraoperative parameters were associated with blood transfusion and angioembolisation rates.…”

Percutaneous Nephrolithotomy for Kidney Stones in Patients with Hematological Malignancy

“…Although the general opinion on cardiac surgery is that it does not exacerbate HM in patients in the remission period, a probable increase in WBC count after the surgery may stimulate a leucomoid reaction, which can lead to a relapse in an otherwise quiescent illnes [15,17]. Since the rate of septic shock after PNL operations has been reported as 2.4% in the literature and preoperative urine WBC count and operation time >90 minutes are two significant risk factors, the HM patients in the remission period prior the PNL surgery still have the risk for complication [18]. However, in our study the surgical trauma didn't lead any increase the hematological problems or leukaemic transformation although a slight increase in WBC count after the operation.…”

Percutaneous Nephrolithotomy Induced Renal Hemorrhage in a Patient with Bilateral Double Renal Arteries: A Case Report and Literature Review

“…However, severe hemorrhage after percutaneous nephrolithotomy is a rare complication (less than 1%) but life-threatening event [6]. Several risk factors, such as upper caliceal puncture, solitary kidney, staghorn stone, multiple punctures and inexperienced surgeon were associated with increased renal hemorrhage during PCNL [2]. If local tamponade fails to control bleeding, the current treatment of choice is SRAE [3] [7].…”

“…Although this technique is safe and effective, complications, including hemorrhages, have been reported and become a severe cause of patient morbidity [2]. Super-selective renal artery embolization (SRAE) of the injured vessel is an effective, minimally invasive and relatively easy procedure in experienced centers, with high rate of success and immediate benefits, thus saving the patient from the morbidity those results from severe renal bleeding [3].…”