UroToday - &#8730 Post-Percutaneous Nephrolithotomy Extensive Hemorrhage: A Study of Risk Factors

November 21, 2009

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Renal Cancer

√ Post-Percutaneous Nephrolithotomy Extensive Hemorrhage: A Study of Risk Factors

Wednesday, 21 March 2007

√ Editor's Pick: BERKELEY, CA (UroToday.com) - This is by far the most comprehensive review of bleeding complications after percutaneous nephrolithotomy published to date.

The authors reviewed the results of 3,878 percutaneous nephrolithotomy procedures between 1995 and 2005. The incidence of blood transfusion was only 5.5% while severe bleeding was noted in 1%. The primary cause of hemorrhage was a pseudoaneurysm followed by areteriovenous fistula and arterial laceration. In 92% of the patients, the bleeding was controlled with angiographic embolization; 3 patients were urgently explored. There was one death. A multivariate analysis, showed that the key risk factors for bleeding with percutaneous nephrolithotomy were: staghorn stone (3.9% vs. < 1%), multiple punctures (2.9% vs. 0.8%), inexperienced surgeon (1.7% vs. 0.6%), solitary kidney (2.9% vs. 0.8%), and upper pole puncture (4.6% vs. 1.2%). The authors make an important point regarding the last; specifically, the upper pole tract needs to be a straight puncture into the kidney and in the axis of the pelvis and ureter in order to avoid torquing on the kidney and possibly tearing the renal parenchyma.

El-Nahas AR, Shokeir AA, El-Assmy AM, Mohsen T, Shoma AM, Eraky I, El-Kenawy MR, El-Kappany HA

J. Urology 177(2): 576-579, February 2007

UroToday.com Renal Cancer Section

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Written by Ralph V. Clayman, MD, a Contributing Editor with UroToday.

Reader Comments

Fellow University of Minnesota
Written by This email address is being protected from spam bots, you need Javascript enabled to view it on 2008-03-04 11:50:32

This interesting manuscript shows basically that PCNL is a very safe procedure (5.5 out of 100 needed blood transfusion) being the most feared complication, active bleeding, reserved to complex cases of staghorn calculi. PCNL for Stag stones demands one upper pole and/or sometimes multiple punctures in addition to an extra dose of experience, all items listed on the "risk factors" for a major bleeding.
The surgeon must always counsel his patients very carefully prior to every PCNL procedure, but particularly in the presence of a staghorn calculus more attention and time should be payed at making it clear to patient the risks of complications and its consequences.

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