WCE 2019: Life Threatening Severe Bleeding Requiring Angioembolization after Percutaneous Nephrolithotomy

Abu Dhabi, United Arab Emirates (UroToday.com) Dr. Hee Youn Kim from the Catholic University of Korea presented his research this morning regarding incidences of severe bleeding angioembolization following percutaneous nephrolithotomy (PCNL). He explained that the puncture for PCNL should ideally traverse the Brodel’s line for bloodless incision, a relatively avascular plane where the anterior and posterior segmental renal artery branches meet. 

It is believed that incisions along the Brodel’s line should decrease the risk of severe bleeding, due to the avascular nature of this plane. It was the aim of Dr. Kim’s study to examine factors contributing to severe bleeding which require angioembolization after PCNL when access is made through the Brodel’s line.   

In his study, Dr. Kim and his team retrospectively analyzed patients who underwent angioembolization following PCNL between 2009 and 2019 and recorded preoperative patient and stone characteristics. They also evaluated pre-angiographic CTs to see whether performing a puncture during PCNL was appropriate and to calculate the degree of angulation in cases with UPJ involvement. An incorrect puncture was defined to be any access pathway beyond Brodel’s area (the area within 20 degrees posterior from the frontal plane of the kidney).  

Dr. Kim was able to report that out of the 1,554 PCNL patients that were analyzed, only 21 (1.4%) of them underwent angioembolization. Furthermore, there were 14 of these 21 patients (66.7%) who were found to have an incorrect puncture identified in the pre-angiographic CT. The 7 remaining cases with correct puncture all showed renal pelvis stones with extension into the upper ureter approached by a lower pole calyceal puncture. In conclusion, Dr. Kim and his team were able to determine that incorrect puncture, which was defined as any access pathway beyond Brodel’s line, and excessive torque were examined in the majority of cases where severe bleeding required angioembolization after PCNL. 

Presented by: Hee Youn Kim, MD, PhD, Assistant professor, St. Vincent's Hospital, the Catholic University of Korea, Suwon, Kyonggi-do, Republic of Korea

Written by: Andrew Shea Afyouni, BS, Junior Research Specialist and Medical Student, University of California, Irvine Department of Urology at the 37th World Congress of Endourology (WCE) – October 29th-November 2nd, Abu Dhabi, United Arab Emirates