Postpercutaneous nephrolithotomy bleeding: aetiology and management.
OBJECTIVE
Postpercutaneous nephrolithotomy (PCNL) bleeding is the most dreaded complication following PCNL. In this article, we refer to risk factors contributing to post-PCNL bleeding and the criteria to decide the line of management in such cases. We further discuss the treatment algorithm for the management of the complication.


RESULTS
A perfect puncture is a 'key' to avoid post-PNL bleeding. Superselective angioembolization (SAE) is an efficacious and well tolerated method of controlling post-PCNL bleeding, and the success rate of SAE is found to be greater than 80%. Pseudoaneurysm is the commonest finding of SAE, which is responsible for post-PCNL bleeding. A recent study suggested that multiple percutaneous accesses, more than two bleeding sites identified during renal angiography, and the use of gelatine sponge alone as the embolic material were high-risk factors for the failure of SAE. A significant number of patients experience postinfarction syndrome in varying degree of severity after SAE.


CONCLUSIONS
Post-PCNL bleeding is a life-threatening complication. Most of the post-PCNL bleeds subside with conservative management, and SAE is an effective means of controlling post-PCNL bleeding. A skilled interventionist can achieve successful control of bleeding with a variety of agents available. Multiple punctures and evidence of more than two lesions predict high risk of failure of SAE.
Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
Arvind P
AP
Ganpule
Darshan H
DH
Shah
Mahesh R
MR
Desai
D000465:Algorithms; D019091:Critical Pathways; D006489:Hemostatic Techniques; D006801:Humans; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D012307:Risk Factors; D016896:Treatment Outcome