Percutaneous Endoscopic Treatment of Complicated Delayed Bleeding Postpercutaneous Nephrolithotomy: A Novel Suggestion

An assessment of the efficacy and safety of balloon nephrostomy traction in minimizing postoperative bleeding of percutaneous nephrolithotomy: a randomized controlled clinical trial

PURPOSE

Percutaneous nephrolithotomy (PCNL) as an established procedure for treatment of large kidney stones, can trigger life threatening complications. Postoperative hemorrhaging is one of the main complications of PCNL. This study investigates the effectiveness of balloon nephrostomy in reducing hemorrhage in the postoperative phase of PCNL.

METHODS AND MATERIALS

A total of 102 patients underwent routine PCNL and then they were randomly allocated to intervention and control groups. For the intervention group, a balloon nephrostomy tube was inserted under guidance of fluoroscopy, gentle traction was applied on the nephrostomy and then it was fixed to skin under mild traction. A conventional nephrostomy tube was inserted in the control group without additional traction. Blood loss was estimated by hemoglobin drop in the first 24 h after surgery. Hemoglobin level drop was the primary endpoint of interest. Secondary endpoints were postoperative complications and were compared between treatment groups.

RESULTS

The mean first 24-hour hemoglobin drop was 0.9 ± 0.2 mg/dL in the intervention group and 2.1 ± 0.2 mg/dL in the control group which was statistically significant (< 0.001). Although blood transfusion was more common in the control group (8% versus 0%), it was not statistically significant. There were no statistically significant differences between intervention and control groups regarding the postoperative complications.

CONCLUSION

In conclusion, the results of the present study show the effectiveness of the application of balloon nephrostomy in decreasing PCNL postoperative bleeding without considerable complication.

TRIAL REGISTRATION NO

IRCT20160406027253N2.

Percutaneous re-surgical approach for delayed bleeding caused by pseudoaneurysm following percutaneous nephrolithotomy

Post percutaneous nephrolithotomy (PCNL) vascular complications included arteriovenous fistula and pseudoaneurysm can cause early or late bleeding and result in unstable condition. Selective trans-arterial embolization is the gold standard technique to manage arterial pseudoaneurysm. Herein, we present a case of pseudoaneurysm following PCNL and describe an alternative technique for its removal using a grasper under C-arm vision. Percutaneous re-surgical approach to post-PCNL hemorrhage due to pseudoaneurysm by using a nephro-grasper to pick up the renal artery pseudoaneurysm would be safe, effective and can provide a direct view of pyelocaliceal system for surgeons; And can be a proper alternative for angioembolization.