Hemorrhage due to arteriovenous fistula (AVF) or pseudoaneurysm (PA) is a rare complication after percutaneous nephrolithotomy (PCNL). The objective of this study is to evaluate hemorrhagic complications (HC) after PCNL and the results of their endovascular treatment.
Between May 2009 and December 2019, 1335 PCNL were performed in our center for kidney stone disease. We analyzed the incidence of early and late HC, their management, the need for subsequent embolization, as well as clinical and analytical data of these patients.
A total of 59 (4.4%) patients presented HC. Bleeding was managed with arteriography and selective embolization (ASE). Perirenal hematoma was seen in 38 patients (64%). Regarding angiographic findings, there were 32 (54%) PA, 8 (14%) AVF, 4 (7%) extravasations due to vascular laceration and 15 (25%) PA combined with AVF. In one case, 3 procedures were required to control the bleeding. In 30 patients (51%) blood transfusions were not necessary, while in 29 (49%), a mean of 1.3 units were transfused. Median follow-up was 24±21 months. Mean time interval between PCNL and ASE was 7.3±4.9 days. A total of 24 (41%) patients were readmitted after discharge due to late HC requiring ASE. Delay between readmission and ASE was 4.8±4.6hours in average.
Early and late HC after PCNL can be severe. Rapid identification and treatment with ASE is an effective and minimally invasive and avoids multiple blood transfusions which in many cases constitute an insufficient treatment.
Actas urologicas espanolas. 2021 Sep 03 [Epub ahead of print]
A Alabat Roca, C Torrecilla Ortíz, J M Cuadrado Campaña, S Colom Freixas, J Fernández-Concha Schwalb, S Beato García, E Alba Rey, D León Guevara, F Vigués Julià
Servicio de Urología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España. Electronic address: ., Servicio de Urología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España., Área de Angiorradiología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España.