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Post-Percutaneous Nephrolithotomy Extensive Hemorrhage: A Study Of Risk Factors

October 12, 2017

UroToday- This is by far the most comprehensive review of bleeding complications after percutaneous nephrolithotomy published to date. The authors reviewed the results of 3,878 percutaneous nephrolithotomy procedures between 1995 and 2005. The incidence of blood transfusion was only 5.5% while severe bleeding was noted in 1%. The primary cause of hemorrhage was a pseudoaneurysm followed by areteriovenous fistula and arterial laceration. In 92% of the patients, the bleeding was controlled with angiographic embolization; 3 patients were urgently explored. There was one death. A multivariate analysis, showed that the key risk factors for bleeding with percutaneous nephrolithotomy were: staghorn stone (3.9% vs. < 1%), multiple punctures (2.9% vs. 0.8%), inexperienced surgeon (1.7% vs. 0.6%), solitary kidney (2.9% vs. 0.8%), and upper pole puncture (4.6% vs. 1.2%). The authors make an important point regarding the last; specifically, the upper pole tract needs to be a straight puncture into the kidney and in the axis of the pelvis and ureter in order to avoid torquing on the kidney and possibly tearing the renal parenchyma.

El-Nahas AR, Shokeir AA, El-Assmy AM, Mohsen T, Shoma AM, Eraky I, El-Kenawy MR, El-Kappany HA

J. Urology 177(2): 576-579, February 2007 Reviewed by UroToday Medical Editor Ralph V. Clayman, MD

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