[Hemorrhagic complications during percutaneous nephrolithotomy. Retrospective studies of 772 cases]

Abstract

Objectives: To evaluate the haemorrhagic complications of PCNL, to analyse their management and to identify predisposing factors.

Material and methods: Out of a series of 772 cases of PCNL, 18 patients developed severe haemorrhage requiring a haemostatis procedure (2.3%): 13 males and 5 females with a mean age of 57 years (38-79), and one case on a solitary kidney. The mean time to onset of haemorrhage was 18 days (--48 days).

Results: Three nephrectomies for haemostatis were performed at the beginning of our experience. Renal arteriography was performed in 15 patients and was abnormal in 13 patients, showing 3 arteriovenous fistulas, 8 false aneurysms, 3 arteriolar injuries. All these vascular abnormalities were successfully treated by highly selective embolization. In 2 cases, arteriography was normal with a spontaneously favourable course. Comparison of the 2 groups of PCNL, with haemorrhage versus without haemorrhage, failed to demonstrate any risk factors.

Conclusion: Severe haemorrhage following PCNL is a rare complication, but impossible to predict. Selective embolization allows control of bleeding and currently constitutes the treatment of choice.