Post-Percutaneous Nephrolithotomy Bleeding Management. Lessons Learned In 20 Years

Main Category: Urology / Nephrology
Article Date: 02 Jul 2008 - 5:00 PDT

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ORLANDO, FL (UroToday.com) - Minimally invasive endourological surgery for renal stone diseases i.e. percutaneous nephrolithotomy (PNL) has been shown to be safe but has its potential serious complications such as massive hemorrhage which can be acute or delayed. The group from India evaluated the incidence, demography, and cause of bleeding from 5,847 patients who underwent percutaneous nephrolithotomy from 1985 and 2006.

Of note, there were 32 patients who had serious vascular complication. Pre-operative work-ups on coagulation profiles were normal. Interestingly, the time of presentation varied, with the majority presenting during the second to eighth postoperative week (63%, 20/32), 9 (28%) in the first week and 3 (9%) greater than 8 weeks. Angiography showed an arteriovenous fistula in 41%, a pseudoaneurysm in 41% and showed nothing significant in 18%. The bleeding was managed successfully in majority (81%) of patients using super selective angioemboliszation. However, 6 patients failed angioembolization, and the bleeding was managed with nephroscopy and cauterization of bleeding points (n=2) or exploration of the tract (n=4) with 2 patients ultimately requiring nephrectomy for life threatening bleeding.

The study showed the potential causes and treatment options of hemorrhagic complications of PNL. The role of super selective angioembolization in the control of bleeding was likewise highlighted. They stressed that adherence to the basic principles of PNL specifically optimal puncture through the calyx, controlled dilatation of the tract, and careful manipulation of the instruments may potentially prevent or limit these vascular complications.

Presented by Muthu Veeramoni, MD, Arvind Ganpule, MD, Sharad Bapat, MD, Mahesh Desai Nadiad, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor Aldrin Joseph R. Gamboa, MD

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