Postpercutaneous nephrolithotomy bleeding: aetiology and management

作者：Ganpule Arvind P; Shah Darshan H; Desai Mahesh R^*

来源：Current Opinion in Urology, 2014, 24(2): 189-194.

DOI：10.1097/MOU.0000000000000025

• bleeding
• embolization
• percutaneous nephrolithotomy

Purpose of reviewPostpercutaneous 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.Recent findingsA 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.SummaryPost-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.

• 出版日期2014-3