CU 59. Characteristics of renal hemorrhage after percutaneous nephrolithotomy and timing of selective embolization

Objective: To investigate the characteristics of severe renal hemorrhage after percutaneous nephrolithotomy and timing of selective transarterial embolization (TAE).

Methods: Between May 2005 and March 2010, superselective renal angiography was needed to control severe bleeding after 15 of 1418 cases (1520 PCNL procedures) (1.06%), and superselective renal angioembolization was need to control severe bleeding for 13cases (0.92%). The medical records of all patients who underwent renal angiography and angioembolization for were reviewed.

Results: Severe bleeding after PCNL can be dividide into 3 types according to the clincal characteristics: type I (Urgency type), type II (Intermittence type) and type III (Persistance slow type). There were 3 patients of type I, 6 patients of type II and 3 patients of type III. All patients had a normal coagulation profile before surgery. A total of 11 patients (84.6%) underwent the first time successful embolization and 2 patients underwent the second time successful embolization. The longer time between angioembolization and bleeding was, the more blood loss and transfusion volume were, except one patient of type II bleeding. Temporality serum Crea abnormity was found in two patients, one was a solitary kidney patient, the other was angioembolization for both renal bleeding.

Conclusions: TAE is a minimally invasive, safe, simple, and highly effective modality, in expert hands, for the management of post PCNL renal bleeding. This option should be considered early in the management of these cases, especially for Urgency type bleeding.