Vascular complications after percutaneous nephrolithotomy: are there any predictive factors?
OBJECTIVE
To evaluate the severe hemorrhagic complications of percutaneous nephrolithotomy (PNL) and their management and to analyze the predictive factors.


METHODS
We retrospectively analyzed the data of 1854 patients who had undergone PNL for removal of renal calculi at our institute between 1993 and 2003. All patients were resuscitated with intravenous fluids and blood transfusions. Patients in whom bleeding did not respond to conservative means underwent angiography and subsequent embolization. Multivariate analyses were done to determine the various factors responsible for the occurrence of these lesions.


RESULTS
Of the 1854 patients, 27 (1.4%), with a mean age of 38.6 years (range 19 to 63) required angiography and/or embolization for bleeding control. The mean time to the onset of hemorrhage was 8 days (range 2 to 18). Renal arteriography revealed pseudoaneurysm in 13, arteriovenous fistula in 6, a combination of both in 4, lumbar artery injury in 1, and no lesion in 3 patients. In 22 patients, successful embolization of the offending vessel was achieved and in 2 the hematuria recurred. These 2 patients underwent repeat angiography and embolization of the lesion. Metallic coils were used in 13, Gelfoam in 5, and coils and Gelfoam in 8 patients. On multivariate analysis, only stone size was the significant factor predicting for the occurrence of these vascular complications.


CONCLUSIONS
Severe hematuria is a rare complication of PNL that can be successfully managed with angioembolization. Our results indicated that stone size significantly predicted for the occurrence of lesions in patients undergoing PNL for symptomatic stone disease.
Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. anees@sgpgi.ac.in
Aneesh
A
Srivastava
Kamal Jeet
KJ
Singh
Amit
A
Suri
Deepak
D
Dubey
Anant
A
Kumar
Rakesh
R
Kapoor
Anil
A
Mandhani
Sunil
S
Jain
D000328:Adult; D005260:Female; D006417:Hematuria / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014652:Vascular Diseases / Q000209:etiology