Splenic injury is a rare complication after left sided percutaneous nephrolithotomy (PCNL). Although initial observation is often espoused, the natural history of non-operative, conservative management is not well established and the implications of splenic injury are not fully defined in this context. We sought to describe outcomes of conservative management of splenic injury incurred at PCNL.
We performed a multi-institutional retrospective review of individual patients who underwent PCNL complicated by trans-splenic nephrostomy access injury. Demographic info, intraoperative data, management strategies, and outcomes were reviewed.
Nine patients suffered splenic injury after left PCNL. All patients had supracostal, upper pole access under fluoroscopic guidance. Splenic injury was identified by computerized tomography (CT) in the eight of nine (89%) who had imaging on first postoperative day. All eight patients were managed conservatively with nephrostomy dwell time of 2-21 days, one of whom (11%) required blood transfusion. The remaining patient (11%) - who had tubeless PCNL without postop imaging presented five days postoperatively with a delayed bleed and underwent emergent splenectomy. Seven of the nine (78%) were successfully managed non operatively and without need for transfusion or embolization.
The majority of patients incurring splenic injury during PCNL can be successfully managed conservatively with maintenance of nephrostomy tube for two days or greater. Consequences of unrecognized splenic injury may include splenic bleed and may prompt transfusion and/or splenectomy, underscoring role of routine postoperative CT to allow timely diagnosis, particularly in those undergoing upper pole, supracostal left sided percutaneous renal access.
Journal of endourology. 2020 May 02 [Epub ahead of print]
Vivian Paredes-Bhushan, Eric P Raffin, John D Denstedt, Ben H Chew, Bodo E Knudsen, Nicole Miller, Manoj Monga, Mark Noble, Vernon M Pais
Dartmouth College Geisel School of Medicine, 12285, Hanover, New Hampshire, United States; ., Dartmouth-Hitchcock Medical Center, 22916, Urology, Lebanon, New Hampshire, United States; ., UWO, 6221, st Josephs hospital, London, Ontario, Canada, N6A 3K7; ., The University of British Columbia, 8166, Urologic Sciences, Vancouver, British Columbia, Canada., Ohio State University Medical Center, 12306, Department of Surgery, Division of Urology, Columbus, Ohio, United States., Vanderbilt University Medical Center, 12328, Urology, Nashville, Tennessee, United States., Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Cleveland, Ohio, United States., Cleveland Clinic Glickman Urological and Kidney Institute, 273142, Cleveland, Ohio, United States; ., Dartmouth-Hitchcock Medical Center, 22916, Urology, Lebanon, New Hampshire, United States.
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