Transarterial Embolization of Renal Vascular Lesions after Percutaneous Nephrolithotomy

  • T Chandru Associate Professor, Department of Urology
  • R Neelakandan Assistant Professor, Department of Urology
  • K Natarajan Professor, Department of Urology
Keywords: Angioembolization, Post-PCNL bleeding, Renal pseudoaneurysms


Introduction: Percutaneous nephrolithotomy (PCNL) is a safe and effective procedure in the surgical management of renal stone disease. Hematuria is one of the most common complications following PCNL. In most cases, the bleeding is self-limited and do not require surgical intervention. Renal arteriography with selective angiographic embolization is required in patients with massive hemorrhage or continuous hematuria. Our aim was to evaluate the effectiveness of percutaneous transarterial embolization for the treatment of renal pseudoaneurysms following post-PCNL bleeding.
Materials and Methods: A total of 852 patients who underwent PCNL for renal calculus, between March 2014 and October 2017 and included 12 patients who had undergone renal embolization due to significant post-PCNL renal artery bleeding. The site, number, and type of bleeding lesions, and the result of the embolization procedure were recorded. We report on the incidence, treatment, radiological and clinical results of these serious vascular injuries at our institution.
Results: Our study has included a large group of patients, the 100% angiographic success rate confirming that percutaneous transcatheter embolization is a valuable treatment for most renal vascular injuries. Renal angiography revealed pseudoaneurysm in 10 patients, arteriovenous fistula in 1, and arterial laceration in 1 patients. Significant risk factors on univariate analysis for severe hematuria requiring superselective angiography were multiple/staghorn calculi, upper calix puncture, and history of pyelonephritis. The severity of the hematuria after PCNL is influenced by many factors, including mean stone size and mean operative time, and is correlated with duration of hospitalization and mean hemoglobin drop.
Conclusions: Percutaneous transarterial embolization of the injured vessel is an effective,f minimally invasive and relatively easy procedure in experienced centers, with a high rate of success and immediate benefits, thus saving the patient from the morbidity that result from severe renal bleeding.

Author Biographies

T Chandru, Associate Professor, Department of Urology

Sri Ramachandra Medical Centre, Chennai, Tamil Nadu, India

R Neelakandan, Assistant Professor, Department of Urology

Sri Ramachandra Medical Centre, Chennai, Tamil Nadu, India

K Natarajan, Professor, Department of Urology

Sri Ramachandra Medical Centre, Chennai, Tamil Nadu, India


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