Characteristics of renal hemorrhage after percutaneous nephrolithotomy and the timing of selective embolization:A report of 13 cases / 北京大学学报(医学版)

ABSTRACT

Objective:To investigate the characteristics of severe renal hemorrhage after percutaneous nephrolithotomy(PNL) and timing of selective transarterial embolization(TAE).Methods:Between May 2005 and March 2010,superselective renal angiography was used to control severe bleeding in 15 of 1 418 cases(1 520 PNL procedures,1.06%).In the 15 cases,superselective renal angioembolization was used to control severe bleeding in 13(0.92%).The medical records of all the patients who underwent renal angiography and angioembolization were reviewed.Results:Severe bleeding cases after PNL were dividide into 3 types according to the clinical characteristics:type Ⅰ(urgency type),type Ⅱ(intermittence type) and type Ⅲ(persistant slow type).There were 3 patients in type Ⅰ,6 in type Ⅱ and 6 in type Ⅲ.All the patients had a normal coagulation profile before surgery.A total of 11 patients(84.6%) underwent the first-time successful embolization and 2(15.4%) the second-time successful embolization.The longer time between angioembolization and bleeding was,the more blood loss and transfusion volume were,except for 1 patient in type Ⅱ.Temporality serum creatinine abnormity was found in 2 patients,one with a solitary kidney patient and the other with angioembolization for both renal bleeding.Conclusion:TAE is a minimally invasive,safe,simple,and highly effective modality for the management of post PNL renal bleeding.This option should be considered early in the management of these cases,especially for Urgency type bleeding.