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Syarif S, Azis A, Rahmat A S, Fadillah Zainal AT, Nusraya A. Factors associated to hemoglobin decrease after percutaneous nephrolithotomy: a retrospective study. Arch Ital Urol Androl 2024; 96:12382. [PMID: 38767891 DOI: 10.4081/aiua.2024.12382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/24/2024] [Indexed: 05/22/2024] Open
Abstract
OBJECTIVE This study aims to determine the preoperative and perioperative risk parameters associated with a decrease in hemoglobin (Hb) in patients undergoing percutaneous nephrolithotomy (PCNL). METHODS We collected prospective data of consecutive patients who underwent PCNL from January 2018 to December 2022. The median decrease in post-operative hemoglobin levels compared to pre-operative was found to be 1.5 g/dl. This value was the cut-off value that divided the sample into two groups. Group 1 has a decrease in Hb levels that is higher or equal to the cutoff, group 2 has a decrease in Hb levels that is lower than the cut-off. All preoperative, stone characteristics and perioperative factors were recorded. RESULTS A total of 273 patients were included in the study, 141 in Group 1 and 132 in Group 2. The mean age of Group 1 was significantly higher (55.48 ± 8.73 vs 45.9 ± 10.75 years, p < 0.05). The mean bleeding of Group 1 was significantly higher (285.85 ± 113.68 vs 135 ± 77.54 ml, p < 0.05). There was a significant difference in mean operation time between groups (86.35 ± 32.05 vs 64.89 ± 27.83 min, p < 0.05). Multivariate analysis showed that the variables age, comorbid diabetes mellitus, intraoperative bleeding amount, and operation time had a significant relationship with Hb reduction in patients undergoing PCNL (p < 0.05). CONCLUSIONS Older age, comorbid diabetes mellitus, large amounts of intraoperative bleeding, and longer operating time are factors associated with PCNL-related postoperative hemoglobin decrease.
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Affiliation(s)
- Syarif Syarif
- Division of Urology, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar.
| | - Abdul Azis
- Division of Urology, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar.
| | - Saidah Rahmat A
- Faculty of Medicine, Muhammadiyah Malang University, Malang.
| | | | - Ade Nusraya
- Faculty of Medicine, Hasanuddin University, Makassar.
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Tadayon N, Refaei M, Zarrintan S, Shahsavari S, Najari D, Sheikhzadeh M. Post-percutaneous nephrolithotomy pseudo aneurysm formation treated by coil embolization; A study of seven cases. J Cardiovasc Thorac Res 2024; 16:55-59. [PMID: 38584656 PMCID: PMC10997973 DOI: 10.34172/jcvtr.32905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 02/17/2024] [Indexed: 04/09/2024] Open
Abstract
Renal artery pseudoaneurysm is a rare complication of percutaneous nephrolithotomy (PCNL) with symptoms of flank pain and hematuria. Endovascular coil embolization has been proposed as a safe management option. We report Seven male patients, aged 36 to 65 years, with post-PCNL pseudoaneurysms presenting as gross hematuria. They all underwent CT angiography prior to endovascular intervention. The access was from common femoral artery in 6 cases and from left brachial artery in one case. Selective angiography of affected renal artery and branches were performed by suitable catheter. Coil embolization was performed by MicroNester and MReye coils (Cook, Inc.). Size of coils was selected based on angiography results. Completion angiography revealed embolized pseudoaneurysm in all cases. Gross and microscopic hematuria disappeared in all patients in the following days. Endovascular angioembolization with coil is an effective technique for managing post-PCNL pseudoaneurysms in renal artery and its branches.
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Affiliation(s)
- Niki Tadayon
- Clinical Research Developmental Unit of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Meisam Refaei
- Department of General & Vascular Surgery, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Zarrintan
- Division of Vascular & Endovascular Surgery, University of California, San Diego,California,USA
| | - Saleh Shahsavari
- Department of Surgery, Shohada Tajrish Hospital,Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Doras Najari
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Sheikhzadeh
- Department of General & Vascular Surgery, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Kazemi R, Jandaghi F, Montazeri F, Salehi H. Acute liver injury and contralateral pleural effusion as two rare complications following percutaneous nephrolithotomy: a case report. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2024; 12:46-51. [PMID: 38500867 PMCID: PMC10944364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/25/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION Percutaneous Nephrolithotomy (PCNL) is a widely used surgical intervention for removing large and complex renal calculi. While considered a safe and effective procedure, it can still lead to severe and rare complications, including bleeding, pulmonary complications, and liver dysfunction. CASE PRESENTATION This case report presents a case who underwent PCNL for a kidney stone and subsequently developed a series of rare and severe complications. Following the PCNL procedure, the patient experienced significant bleeding, a known but uncommon complication of PCNL, pulmonary complications, a common complication that may carry a risk of death, and acute liver failure, an exceedingly rare consequence of PCNL. CONCLUSION In summary, while PCNL is a valuable technique for treating kidney stones, it is not without risk. This case underscores the importance of recognizing and managing rare complications following PCNL surgery, highlighting the need for vigilance, multidisciplinary care, and timely interventions to ensure favorable patient outcomes.
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Affiliation(s)
- Reza Kazemi
- Department of Urology, Isfahan University of Medical SciencesIsfahan, Iran
| | - Faezeh Jandaghi
- Department of Urology, School of Medicine, Al-Zahra Hospital, Isfahan University of Medical SciencesIsfahan, Iran
| | | | - Hanieh Salehi
- School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
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He Q, Song Z, Wang X, Hou B, Hao Z. Influencing Factors of Massive Hemorrhage and High-Grade Renal Vascular Injury after PCNL: A Retrospective Comparative Study. Int J Clin Pract 2023; 2023:5521691. [PMID: 38045654 PMCID: PMC10691886 DOI: 10.1155/2023/5521691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/29/2023] [Accepted: 11/04/2023] [Indexed: 12/05/2023] Open
Abstract
Purpose Severe hemorrhage after percutaneous nephrolithotomy (PCNL) is a rare but alerting event. In this study, we report the factors affecting massive hemorrhage after PCNL, various levels of vascular damage during renal angiography, and the therapeutic effect of superselective renal artery embolization (SRAE). Patients and Methods. A retrospective analysis was performed on the data of 69 patients with postoperative PCNL hemorrhage who underwent SRAE from January 2010 to March 2021. Inclusion criteria for all cases were failure of conservative treatment for severe renal hemorrhage after surgery and then treatment with SRAE. In addition, 98 patients without significant hemorrhage after PCNL were randomly selected as the control group. All clinical data are confirmed by imaging and laboratory examinations. We performed univariate and multivariate analyses to find risk factors of massive hemorrhage and high-grade renal vascular injury after PCNL. Results A total of 69 patients underwent angiography, 64 of which received SRAE due to positive hemorrhages detected by angiography. Urinary tract infection (OR (95% CI) = 11.214 (2.804∼44.842)), high blood pressure (OR (95% CI) = 5.686 (1.401∼23.083)), and no hydronephrosis (OR (95% CI) = 0.189 (0.049∼0.724)) are the most important factors leading to massive hemorrhage after PCNL. In patients who need SRAE after hemorrhage, high-grade vascular injury (grade III) is related to advanced age and decreased hemoglobin. Conclusion During the perioperative period of PCNL, patients with a risk of hypertension, urinary tract infection, and no hydronephrosis should be strengthened to monitor their high risk of postoperative hemorrhage. For patients with postoperative hemorrhage, we can use the patient's age and decreased hemoglobin before and after operation for analysis. In this way, individualized assessment can greatly improve the efficiency of SRAE treatment.
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Affiliation(s)
- Qiushi He
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, China
- Department of Urology, Institute of Urology, Anhui Medical University, Hefei, China
- Department of Urology, Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Ziyan Song
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, China
- Department of Urology, Institute of Urology, Anhui Medical University, Hefei, China
- Department of Urology, Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Xinrui Wang
- School of Life Sciences, Anhui Medical University, Hefei, Anhui, China
| | - Bingbing Hou
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, China
- Department of Urology, Institute of Urology, Anhui Medical University, Hefei, China
- Department of Urology, Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Zongyao Hao
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei, China
- Department of Urology, Institute of Urology, Anhui Medical University, Hefei, China
- Department of Urology, Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
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Banasiewicz T, Machała W, Borejsza Wysocki M, Lesiak M, Krych S, Lange M, Hogendorf P, Durczyński A, Cwaliński J, Bartkowiak T, Dziki A, Kielan W, Kłęk S, Krokowicz Ł, Kusza K, Myśliwiec P, Pędziwiatr M, Richter P, Sobocki J, Szczepkowski M, Tarnowski W, Zegarski W, Zembala M, Zieniewicz K, Wallner G. Principles of minimize bleeding and the transfusion of blood and its components in operated patients - surgical aspects. POLISH JOURNAL OF SURGERY 2023; 95:14-39. [PMID: 38084044 DOI: 10.5604/01.3001.0053.8966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
One of the target of perioperative tratment in surgery is decreasing intraoperative bleeding, which increases the number of perioperative procedures, mortality and treatment costs, and also causes the risk of transfusion of blood and its components. Trying to minimize the blood loss(mainly during the operation) as well as the need to transfuse blood and its components (broadly understood perioperative period) should be standard treatment for a patient undergoing a procedure. In the case of this method, the following steps should be taken: 1) in the preoperative period: identyfication of risk groups as quickly as possible, detecting and treating anemia, applying prehabilitation, modyfying anticoagulant treatment, considering donating one's own blood in some patients and in selected cases erythropoietin preparations; 2) in the perioperative period: aim for normothermia, normovolemia and normoglycemia, use of surgical methods that reduce bleeding, such as minimally invasive surgery, high-energy coagulation, local hemostatics, prevention of surgical site infection, proper transfusion of blood and its components if it occurs; 3) in the postoperative period: monitor the condition of patients, primarily for the detection of bleeding, rapid reoperation if required, suplementation (oral administration preferred) nutrition with microelements (iron) and vitamins, updating its general condition. All these activities, comprehensively and in surgical cooperation with the anesthesiologist, should reduce the blood loss and transfusion of blood and its components.
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Affiliation(s)
- Tomasz Banasiewicz
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Waldemar Machała
- Klinika Anestezjologii i Intensywnej Terapii - Uniwersytecki Szpital Kliniczny im. Wojskowej Akademii Medycznej - Centralny Szpital Weteranów, Łódź
| | - Maciej Borejsza Wysocki
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Maciej Lesiak
- Katedra i Klinika Kardiologii Uniwersytetu Medycznego im. K. Marcinkowskiego w Poznaniu
| | - Sebastian Krych
- Katedra i Klinika Kardiochirurgii, Transplantologii, Chirurgii Naczyniowej i Endowaskularnej SUM. Studenckie Koło Naukowe Kardiochirurgii Dorosłych. Śląski Uniwersytet Medyczny w Katowicach
| | - Małgorzata Lange
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Piotr Hogendorf
- Klinika Chirurgii Ogólnej i Transplantacyjnej, Uniwersytet Medyczny w Łodzi
| | - Adam Durczyński
- Klinika Chirurgii Ogólnej i Transplantacyjnej, Uniwersytet Medyczny w Łodzi
| | - Jarosław Cwaliński
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Tomasz Bartkowiak
- Oddział Kliniczny Anestezjologii, Intensywnej Terapii i Leczenia Bólu, Uniwersytet Medyczny im. K. Marcinkowskiego w Poznaniu
| | - Adam Dziki
- Klinika Chirurgii Ogólnej i Kolorektalnej Uniwersytetu Medycznego w Łodzi
| | - Wojciech Kielan
- II Katedra i Klinika Chirurgii Ogólnej i Chirurgii Onkologicznej, Uniwersytet Medyczny we Wrocławiu
| | - Stanisław Kłęk
- Klinika Chirurgii Onkologicznej, Narodowy Instytut Onkologii - Państwowy Instytut Badawczy im. Marii Skłodowskiej-Curie, Oddział w Krakowie, Kraków
| | - Łukasz Krokowicz
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Krzysztof Kusza
- Katedra i Klinika Anestezjologii i Intensywnej Terapii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Piotr Myśliwiec
- I Klinika Chirurgii Ogólnej i Endokrynologicznej, Uniwersytet Medyczny w Białymstoku
| | - Michał Pędziwiatr
- Katedra Chirurgii Ogólnej, Wydział Lekarski, Uniwersytet Jagielloński - Collegium Medicum, Kraków
| | - Piotr Richter
- Oddział Kliniczny Chirurgii Ogólnej, Onkologicznej i Gastroenterologicznej Szpital Uniwersytecki w Krakowie
| | - Jacek Sobocki
- Katedra i Klinika Chirurgii Ogólnej i Żywienia Klinicznego, Centrum Medyczne Kształcenia Podyplomowego, Warszawski Uniwersytet Medyczny, Warszawa
| | - Marek Szczepkowski
- Klinika Chirurgii Kolorektalnej, Ogólnej i Onkologicznej, Centrum Medyczne Kształcenia Podyplomowego, Szpital Bielański, Warszawa
| | - Wiesław Tarnowski
- Klinika Chirurgii Ogólnej, Onkologicznej i Bariatrycznej CMKP, Szpital im. Prof. W. Orłowskiego, Warszawa
| | | | - Michał Zembala
- Wydział Medyczny, Katolicki Uniwersytet Lubelski Jana Pawła II w Lublinie
| | - Krzysztof Zieniewicz
- Katedra i Klinika Chirurgii Ogólnej, Transplantacyjnej i Wątroby, Warszawski Uniwersytet Medyczny, Warszawa
| | - Grzegorz Wallner
- II Katedra i Klinika Chirurgii Ogólnej, Gastroenterologicznej i Nowotworów Układu Pokarmowego, Uniwersytet Medyczny w Lublinie
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Muacevic A, Adler JR, Sharma P, Mittal A, Chauhan U. N-butyl 2-Cyanoacrylate (NBCA) in Nephron Sparing Superselective Embolization of Iatrogenic Renovascular Injuries: A Single Centre Experience. Cureus 2022; 14:e33166. [PMID: 36726905 PMCID: PMC9885729 DOI: 10.7759/cureus.33166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2022] [Indexed: 01/01/2023] Open
Abstract
Purpose To evaluate the safety and efficacy of N-butyl-2-cyano-acrylate (NBCA) for endovascular management of iatrogenic renal-vascular injuries and effects on renal function. Material & Methods Fifteen patients with diagnosed or suspected iatrogenic renal vascular injuries, following percutaneous procedures formed the study group. All the patients were having retroperitoneal hemorrhage or hematuria, with hemodynamic instability at the time of presentation. Pseudoaneurysms, active extravasation of contrast, and the arteriovenous fistula were identified as the cause of bleeding on digital subtraction angiography. Patients underwent trans arterial super-selective embolization. Renal function was monitored using serum creatinine, estimated glomerular filtration rate (eGFR), and mean blood pressure of all the patients at immediate post-procedure and two months intervals. Results Technical and clinical success was achieved in all the cases using NBCA alone. Patients improved hemodynamically. None of the patients required repeat embolization. No derangement in renal function was observed immediately after the procedure and at interval follow-up. Conclusion NBCA can be used as a safe embolizing agent to provide a quick and effective cure for iatrogenic renovascular injuries. Renal parenchymal loss can be minimized by super selective technique.
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Nasseh H, Mokhtari G, Ghasemi S, Biazar G, Kazemnezhad Leyli E, Gholamjani Moghaddam K. Risk Factors for Intra-operative Bleeding in Percutaneous Nephrolithotomy in an Academic Center: A Retrospective Study. Anesth Pain Med 2022; 12:e126974. [PMID: 36937085 PMCID: PMC10016121 DOI: 10.5812/aapm-126974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/04/2022] [Accepted: 08/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background Percutaneous nephrolithotomy (PNL) is the treatment of choice for renal stones as a safe, effective, and minimally invasive method. However, bleeding remains a major concern in the procedure. Objectives This study aimed to investigate the risk factors of bleeding in PNL. Methods This retrospective descriptive cross-sectional study was conducted in the Urology department of Razi hospital. The data of patients with urinary calculi staghorn type who underwent PNL in a prone position under general anesthesia were recorded. A checklist including patients' demographics, surgical characteristics, and outcomes was filled out for each patient. Results The data from 151 complete files were gathered. The mean age of the cases was 47.89 ± 12.41 years. The mean hemoglobin (Hb) drop was 1.92 ± 1.56 mg/dL. At least 1 mg/dL Hb drop was observed in all cases. The highest Hb drop was 3 mg/dL.). There was no significant relationship between stone bulk, age, BMI, GFR, surgery duration, and the number of tracts, and Hb drop during PNL (P > 0.05). But there was a positive correlation between Urinary Tract Infection (UTI) history (P = 0.01) and transfusion (P = 0.0001) and Hb drop during PNL. Also, the history of open kidney surgery (P = 0.031), nephrostomy insertion (P = 0.003), and extracorporeal shock wave lithotripsy therapy (ESWL) (P = 0.041) were correlated with the increased risk of Hb drop. Conclusions Urinary tract infection, history of open surgery, nephrostomy implantation, and ESWL were significantly associated with more bleeding in PNL.
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Affiliation(s)
- Hamidreza Nasseh
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Gholamreza Mokhtari
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Samira Ghasemi
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gelareh Biazar
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
- Corresponding Author: Anesthesiology Research Center, Alzahra Hospital, Guilan University of Medical Sciences, 4144654839, Rasht, Iran. Tel: +98-1333369328,
| | - Ehsan Kazemnezhad Leyli
- Guilan Road Trauma Research Center, Biostatistics Department, Guilan University of Medical Sciences, Rasht, Iran
| | - Keivan Gholamjani Moghaddam
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Xu Z, Liu K, Lv J, Zhang Y. Application of CTU-Assisted Doppler Ultrasound Puncture in Nontube Percutaneous Nephrolithotomy, Its Effect on Patients' Complications, and Its Clinical Value. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7810062. [PMID: 35937406 PMCID: PMC9352473 DOI: 10.1155/2022/7810062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/29/2022] [Accepted: 07/12/2022] [Indexed: 11/17/2022]
Abstract
Objective To research the application of CTU-assisted Doppler ultrasound puncture in uncatheterized PCNL, its influence on patients' complications, and its clinical value in a case-control study. Methods One hundred and forty-four patients who went through percutaneous nephrolithotomy (PCNL) from March 2019 to June 2021 in our hospital were arbitrarily assigned into the CTU group (n = 72) and CT plain scan group (n = 72). CTA+CTU was adopted to determine the puncture passage in the CTU group, and CT scan was employed in the CT group. The intraoperative blood loss, postoperative blood loss, operation time, hospital stay, primary stone removal rate, and the incidence of intraoperative and postoperative complications were compared. The visual analogue score (VAS) was employed to assess the degree of postoperative wound pain. Results The first-stage stone removal rate in the CTU group was 95.83% (69/72), which was remarkably higher compared to the CT plain scan group, which was 81.94% (59/72), and the difference was statistically significant (P < 0.05). The overall rates of intraoperative complications were 6.94% (5/72) in the CTU group and 18.06% (13/72) in the CT plain scan group, respectively, which exhibited great differences (P < 0.05). In addition, the overall rates of intraoperative complications were 2.78% (2/72) in the CTU and 13.89% (10/72) in the CT plain scan group, respectively, and the difference was statistically significant (P < 0.05). The operation time and postoperative hospital stays in the CTU group were remarkably shorter compared to the CT group, and the difference was statistically significant (P < 0.05). The intraoperative and postoperative blood loss of CTU group displayed obvious less than that of the CT group, and the difference was statistically significant (P < 0.05). The VAS were compared 24 hours after surgery. After operation, the VAS of 24 hours after operation in the CTU group (0.92 ± 0.12) were remarkably lower compared to the CT group (1.22 ± 0.15), and the difference was statistically significant (P < 0.05). Discussion. PCNL is constantly being optimized by CTU-assisted Doppler ultrasound puncture to improve stone clearance rates, reduce postoperative bleeding, be less painful, provide rapid recovery, and provide safe and feasible results. It is therefore worthwhile to standardize and then widely promote it in clinical practice.
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Affiliation(s)
- Zhenguo Xu
- Graduate Department, Bengbu Medical College, Bengbu Anhui 233030, China
- Department of Urology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310014, China
| | - Kun Liu
- Graduate Department, Bengbu Medical College, Bengbu Anhui 233030, China
- Department of Urology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310014, China
| | - Jia Lv
- Department of Urology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310014, China
| | - Yuelong Zhang
- Graduate Department, Bengbu Medical College, Bengbu Anhui 233030, China
- Department of Urology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310014, China
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9
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Zhang LW, Fei X, Song Y. Renal pelvis mucosal artery hemorrhage after percutaneous nephrolithotomy: a rare case report and literature review. BMC Urol 2022; 22:100. [PMID: 35820877 PMCID: PMC9277858 DOI: 10.1186/s12894-022-01049-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Following a percutaneous nephrolithotomy (PCNL) procedure, the most common complications are considered to be intraoperative and postoperative bleeding. Many patients with postoperative bleeding can be treated conservatively, causing the perirenal hematoma to resolve spontaneously. The major causes of severe postoperative bleeding are pseudoaneurysms, arteriovenous fistula, and segmental arterial injury. Typically, the first choice of treatment to manage severe bleeding complications is selective angioembolization (SAE) because of the very high success rate associated with this procedure. CASE PRESENTATION This clinical case involves a 56-year-old man who underwent dual-channel PCNL treatment after diagnosing a left kidney staghorn stone and urinary tract infection. The operation was successful, with no apparent signs of bleeding. Tests revealed continued decreasing hemoglobin levels following the procedure. After the conservative treatment failed, renal angiography was performed immediately, indicating renal pelvis mucosal artery hemorrhage. In the three hours post-surgery, the SAE still failed to prevent bleeding. Further discussions led to formulating a new surgical plan using a nephroscope to enter the initial channel where hemostasis began. The hemostasis origin was found precisely in the mucosal artery next to the channel during the operation and was successfully controlled. CONCLUSIONS This case reveals there is poor communication and inadequate discussions about the potential failures of an SAE procedure. Swift clinical decision-making is imperative when dealing with high-level renal trauma to prevent delays in surgery that can threaten the safety of patients.
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Affiliation(s)
- Lv Wen Zhang
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, 110000, China
| | - Xiang Fei
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, 110000, China.
| | - Yan Song
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, 110000, China.
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Pre-Operative Parameters Predicting Hemoglobin Decline Related to Percutaneous Nephrolithotomy. SISLI ETFAL HASTANESI TIP BULTENI 2022; 56:70-76. [PMID: 35515974 PMCID: PMC9040304 DOI: 10.14744/semb.2021.21284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/26/2021] [Indexed: 11/20/2022]
Abstract
Objectives Percutaneous nephrolithotomy (PNL) for upper urinary tract stones is a minimally invasive, effective treatment modality. Despite its high success rates, its potential complications pose a risk. In this study, we aimed to determine the risk factors associated with bleeding which is one of PNL's most important complications. Methods The data of patients who underwent PNL between January 2017 and December 2018 were retrospectively analyzed. The median reduction in post-operative hemoglobin levels compared to preoperative levels was found to be 1.6 g/dl, which was accepted as the threshold value. The patients with hemoglobin decrease above the threshold were assigned as Group 1, and below the threshold as Group 2. Pre-operative, perioperative data, and stone characteristics of the patients were recorded. Results 169 patients, 85 patients in Group 1 and 84 patients in Group 2 were included in the study. The mean age of Group 1 was significantly higher (47.4±7.9 and 32±9.4 years, respectively, p=0.001) Sixteen in Group 1 (18.8%) and six in Group 2 (7, 1%) had a diagnosis of hypertension (HT) and a significant difference was found (p=0.038). The average stone burden was 2733±1121.3 mm3 in Group 1, and 2326.5±975.6 mm3 in Group 2. It was observed that there was a significantly higher stone burden in Group 1 (p=0.001). There was a significant difference between the groups in terms of mean operation time (84.4±7 and 76.2±9.9 min, respectively, p<0.001). When the complication rates were analyzed, complications were observed in 25 (29.4%) patients in Group 1 and 12 (14.2%) patients in Group 2, and a significant difference was found between both groups (p=0.019). Age and HT were found to be significant independent risk factors associated with hemoglobin decline in multivariate analyzes (p<0.001 and p<0.027, respectively). Conclusion In this study; advanced age, presence of HT, and high stone burden were found to be predictive of reductions in hemoglobin levels. Furthermore, a correlation of decreased hemoglobin levels was detected with operative times and occurrence of complications.
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Factors affecting hemostasis in the control of iatrogenic renal hemorrhage. World J Urol 2022; 40:1581-1586. [DOI: 10.1007/s00345-022-03970-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/16/2022] [Indexed: 11/25/2022] Open
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12
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Xie Y, Gao P, He F, Zhang C. Application of Alginate-Based Hydrogels in Hemostasis. Gels 2022; 8:gels8020109. [PMID: 35200490 PMCID: PMC8871293 DOI: 10.3390/gels8020109] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/31/2022] [Accepted: 02/03/2022] [Indexed: 12/24/2022] Open
Abstract
Hemorrhage, as a common trauma injury and clinical postoperative complication, may cause serious damage to the body, especially for patients with huge blood loss and coagulation dysfunction. Timely and effective hemostasis and avoidance of bleeding are of great significance for reducing body damage and improving the survival rate and quality of life of patients. Alginate is considered to be an excellent hemostatic polymer-based biomaterial due to its excellent biocompatibility, biodegradability, non-toxicity, non-immunogenicity, easy gelation and easy availability. In recent years, alginate hydrogels have been more and more widely used in the medical field, and a series of hemostatic related products have been developed such as medical dressings, hemostatic needles, transcatheter interventional embolization preparations, microneedles, injectable hydrogels, and hemostatic powders. The development and application prospects are extremely broad. This manuscript reviews the structure, properties and history of alginate, as well as the research progress of alginate hydrogels in clinical applications related to hemostasis. This review also discusses the current limitations and possible future development prospects of alginate hydrogels in hemostatic applications.
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Affiliation(s)
| | | | | | - Chun Zhang
- Correspondence: ; Tel.: +86-027-85726712
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Seth R, Yadav A, Gupta A. Glue embolization of accessory renal artery pseudo-aneurysm & AVF post-PCNL. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00236-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Cao C, Kim SY, Kim GH, Shin JH, Nam IC, Alali M, Chu HH, Ko HK. Comparison of transradial and transfemoral access for transcatheter arterial embolization of iatrogenic renal hemorrhage. PLoS One 2021; 16:e0256130. [PMID: 34415949 PMCID: PMC8378688 DOI: 10.1371/journal.pone.0256130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/29/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There are few reports of renal artery embolization (RAE) via transradial access (TRA) for renal hemorrhage, and none have compared outcomes of RAE via TRA and transfemoral access (TFA). The objective was to compare technical and clinical outcomes in patients undergoing RAE via TRA or TFA for iatrogenic renal hemorrhage. MATERIALS AND METHODS This study included 45 RAE procedures (16 TRA and 29 TFA) for iatrogenic renal hemorrhage in 43 patients performed at a tertiary referral center between October 2018 and December 2020. Information regarding underlying diseases, coagulation status, angiographic and embolization procedure details, technical and clinical successes, and complications were retrospectively evaluated. RESULTS There were no differences in demographics, underlying diseases, updated Charlson comorbidity scores, angiographic findings, and volume of contrast material between the TRA and TFA groups. By contrast, prothrombin time and international normalized ratio were significantly lower in the TRA than in the TFA group. Embolic materials differed significantly in the two groups. Procedure duration, fluoroscopy time, digital subtraction angiography number, and dose area product were slightly lower in the TRA than in the TFA group, but the differences were not statistically significant. Technical and clinical success rates in the TRA and TFA groups were 100% and 96.6%, and 100% and 96.6%, respectively. No patient in either group experienced procedure-related complications during a 4 week follow-up period. CONCLUSION RAE via TRA in the management of iatrogenic renal hemorrhage was safe and feasible, with similar procedure duration and radiation exposure to RAE via TFA. TRA may be an acceptable alternative to TFA in these patients.
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Affiliation(s)
- Chuanwu Cao
- Department of Radiology, The Tenth People’s Hospital, Shanghai, China
| | - So-Yeon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Gun Ha Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
- * E-mail:
| | - In Chul Nam
- Department of Radiology, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Changwon, Korea
| | - Meshari Alali
- Department of Radiology, Majmaah University, Almajmaah, Saudi Arabia
| | - Hee Ho Chu
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Heung-Kyu Ko
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Poudyal S. Current insights on haemorrhagic complications in percutaneous nephrolithotomy. Asian J Urol 2021; 9:81-93. [PMID: 35198401 PMCID: PMC8841251 DOI: 10.1016/j.ajur.2021.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/10/2020] [Accepted: 12/11/2020] [Indexed: 01/07/2023] Open
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Dong X, Ren Y, Han P, Chen L, Sun T, Su Y, Feng Y, Ma J, Liang H, Zheng C. Superselective Renal Artery Embolization Management of Post-percutaneous Nephrolithotomy Hemorrhage and Its Methods. Front Surg 2020; 7:582261. [PMID: 33324672 PMCID: PMC7725762 DOI: 10.3389/fsurg.2020.582261] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 10/19/2020] [Indexed: 01/20/2023] Open
Abstract
Objective: The purpose of this study was to evaluate the therapeutic efficacy and safety of superselective renal arterial embolization (SRAE) in the treatment of patients with renal hemorrhage after percutaneous nephroscopy (PCNL). In addition, embolization techniques and embolization materials during operation were also worthy of further discussion. Methods: From February 2015 to December 2019, clinical data of 49 consecutive patients with renal hemorrhage after PCNL were retrospectively analyzed. Demographic and clinical data of patients were recorded, changes in serum creatinine values were analyzed, and the safety and efficacy of TAE were evaluated. Clinical experience was also recorded. Results: A total of 49 patients underwent angiography, of which 46 patients received SRAE due to positive hemorrhagic foci detected by angiography, and the technical success rate of 46 patients was 100%. Among the three patients who did not receive embolization, one patient underwent nephrectomy, and two patients improved with conservative treatment, with a clinical success rate of 98%. There was no statistically significant difference between serum creatinine before PCNL and 7 days after SRAE (101.6 ± 36.5 to 100.5 ± 27.1 μmol/L; P = 0.634), and no significant change was observed in serum creatinine at the last follow-up (99.4 ± 34 μmol/L, P = 0.076). No major complications occurred after embolization. Conclusions: SRAE is safe and effective in patients with renal hemorrhage after PCNL. The experience of interventional therapy and the choice of embolization materials in this study may provide certain benefits for the treatment of patients with renal hemorrhage after PCNL.
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Affiliation(s)
- Xiangjun Dong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yanqiao Ren
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Ping Han
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Lei Chen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Tao Sun
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yangbo Su
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yiming Feng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jinqiang Ma
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Huimin Liang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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Liao X, Xu H, Liu F, Min X, Li Y, Yang L, Ren Y. Value of Angioembolization in the Treatment of Iatrogenic Renal Vascular Injury Assisted by 3-Dimensional Digital Subtraction Angiography. Med Sci Monit 2020; 26:e927208. [PMID: 32877388 PMCID: PMC7486794 DOI: 10.12659/msm.927208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This study was conducted to investigate the reliability and efficacy of polyvinyl alcohol combined with coils in the embolization of iatrogenic renal vascular injury with the assistance of 3-dimensional digital subtraction angiography (3D-DSA). MATERIAL AND METHODS Twenty-six patients with minimally invasive renal bleeding who underwent transarterial embolization from January 2012 to January 2019 in our hospital were included in the study. We obtained demographic data from these patients, as well as information on clinical presentation, renal procedures used for treatment, and perioperative details. The changes in renal function tests, serum hemoglobin, serum hematocrit, and technetium Tc 99m dimercaptosuccinic acid (99mTc-DMSA) levels pre- and postembolization were compared. In addition, the embolic area and the technical and clinical success rates were analyzed. Finally, an angiographic manifestation of the renal artery, 3D-DSA, and the effect of embolization were analyzed retrospectively. RESULTS All patients achieved technical and clinical success after embolization (100%, 26/26). There were no significant differences between pre- and postoperative estimated glomerular filtration rate, serum parameters, and 99mTc-DMSA. The embolic area was 12%±10%. Patients did not exhibit severe complications during the follow-up period. CONCLUSIONS Proximal embolization technique assisted by 3D-DSA for renal iatrogenic hemorrhage and vascular lesions is both safe and efficacious, offering high rates for both clinical and technical success. It maximizes the protection of the kidney and reduces the rate of renal resection.
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Affiliation(s)
- Xin Liao
- Intervention Center of Fifth People's Hospital of Nanchong City, Fifth People's Hospital of Nanchong City, Nanchong, Sichuan, China (mainland)
| | - Hao Xu
- Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Sichuan Key Laboratory of Medical Imaging, North Sichuan Medical College, Nanchong, Sichuan, China (mainland)
| | - Fan Liu
- Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Sichuan Key Laboratory of Medical Imaging, North Sichuan Medical College, Nanchong, Sichuan, China (mainland)
| | - Xuli Min
- Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Sichuan Key Laboratory of Medical Imaging, North Sichuan Medical College, Nanchong, Sichuan, China (mainland)
| | - Yugen Li
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Sichuan Key Laboratory of Medical Imaging, North Sichuan Medical College, Nanchong, Sichuan, China (mainland)
| | - Lin Yang
- Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Sichuan Key Laboratory of Medical Imaging, North Sichuan Medical College, Nanchong, Sichuan, China (mainland)
| | - Yongjun Ren
- Department of Interventional Radiology, Affiliated Hospital of North Sichuan Medical College, Sichuan Key Laboratory of Medical Imaging, North Sichuan Medical College, Nanchong, Sichuan, China (mainland)
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Limtrakul T, Rompsaithong U, Ahooja A, Kiatsopit P, Lumbiganon S, Pachirat K, Sirithanaphol W. Renal Artery Embolization for Acute Renal Hemorrhage: A Single-Center Experience. Res Rep Urol 2020; 12:315-319. [PMID: 32802808 PMCID: PMC7415436 DOI: 10.2147/rru.s263012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/28/2020] [Indexed: 12/13/2022] Open
Abstract
Background Emergency renal artery embolization (RAE) is a useful method in treating renal trauma and bleeding renal tumors. The aim of this study was to evaluate the clinical efficacy and safety of emergency RAE, and factors associated with RAE failure. Methods This retrospective study included patients treated with emergency RAE for acute renal hemorrhage between 1 January 2009 and 31 October 2019 in Srinagarind Hospital. The embolization was performed using coils, glues, and/or gel foams. Factors associated with unsuccessful outcomes were analyzed using univariate and multivariate regression analyses. Results A total of 94 patients were treated at the center during the study period with the clinical success rate of 91.5%. The most common cause of acute renal hemorrhage was iatrogenic injury (76.5%). Factors associated with unsuccessful RAE according to multivariate analyses were hypertension (adjusted odds ratio [AOR] 24.2) and ruptured tumor/aneurysm (AOR 26.8). Conclusion RAE is an effective procedure for acute renal hemorrhage. Hypertension and ruptured tumor/aneurysm were negative predictors for success.
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Affiliation(s)
- Tanapoom Limtrakul
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Ukrit Rompsaithong
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Anucha Ahooja
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Pakorn Kiatsopit
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Supanut Lumbiganon
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kachit Pachirat
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Wichien Sirithanaphol
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Li Z, Wu A, Liu J, Huang S, Chen G, Wu Y, Chen X, Tan G. Risk factors for hemorrhage requiring embolization after percutaneous nephrolithotomy: a meta-analysis. Transl Androl Urol 2020; 9:210-217. [PMID: 32420126 PMCID: PMC7214970 DOI: 10.21037/tau.2020.01.10] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background The aim of this meta-analysis was to systematically review and identify the risk factors for severe hemorrhage after percutaneous nephrolithotomy (PCNL). Methods We searched the PubMed and EMBASE database for literature related to the risk factors of severe hemorrhage after PCNL requiring angiography and embolization through to September 2019. The necessary data for each eligible study were extracted by 2 independent reviewers. The Newcastle-Ottawa Scale (NOS) was used for assessing the methodological quality of the included studies. Statistical analyses were conducted using Comprehensive Meta-Analysis version 2 to identify whether there was a statistical association between risk factors and severe hemorrhage post-PCNL. Results The results of this meta-analysis showed that urinary tract infection (UTI) (OR =1.98, 95% CI, 1.21–3.26, P=0.007), diabetes mellitus (OR =4.07, 95% CI, 1.83–9.06, P=0.001), staghorn stone (OR =3.49, 95% CI, 1.25–9.76, P=0.017), and multiple tracts (OR =2.09, 95% CI, 1.33–3.28, P=0.001) were independent risk factors for severe hemorrhage post-PCNL, while hypertension (OR =1.18, 95% CI, 0.58–2.42, P=0.65) showed no significant statistical difference. Conclusions Urologists should focus on the above identified risk factors for severe hemorrhage post-PCNL, including UTI, diabetes mellitus, staghorn stone, and multiple tracts. More high-quality studies with larger sample sizes are needed to validate these conclusions.
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Affiliation(s)
- Zhiqin Li
- Department of Urology, Maoming People's Hospital, Maoming 525000, China
| | - Aiming Wu
- Department of Urology, Maoming People's Hospital, Maoming 525000, China
| | - Jianjun Liu
- Department of Urology, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524000, China
| | - Shuitong Huang
- Department of Urology, Maoming People's Hospital, Maoming 525000, China
| | - Guangming Chen
- Department of Urology, Maoming People's Hospital, Maoming 525000, China
| | - Yonglu Wu
- Department of Urology, Maoming People's Hospital, Maoming 525000, China
| | - Xianxi Chen
- Department of Urology, Maoming People's Hospital, Maoming 525000, China
| | - Guobin Tan
- Department of Urology, Maoming People's Hospital, Maoming 525000, China
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Tan X, Fu D, Feng W, Zheng X. The analgesic efficacy of paravertebral block for percutaneous nephrolithotomy: A meta-analysis of randomized controlled studies. Medicine (Baltimore) 2019; 98:e17967. [PMID: 31770205 PMCID: PMC6890373 DOI: 10.1097/md.0000000000017967] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The analgesic efficacy of paravertebral block for percutaneous nephrolithotomy remains controversial. We conduct a systematic review and meta-analysis to explore the analgesic efficacy of paravertebral block for patients with percutaneous nephrolithotomy. METHODS We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases, and randomized controlled trials (RCTs) assessing analgesic efficacy of paravertebral block for percutaneous nephrolithotomy are included in this meta-analysis. RESULTS Five RCTs are included in the meta-analysis. Overall, compared with control group after percutaneous nephrolithotomy, paravertebral block is associated with the decrease in analgesic consumption (standard mean difference (Std. MD) = -1.55; 95% confidence interval (CI) = -2.18 to -0.92; P < .00001) and additional analgesics (risk ratio (RR) = 0.17; 95% CI = 0.07 to 0.44; P = .0003), prolonged time to first analgesic requirement (Std. MD = 1.51; 95% CI = 0.26 to 2.76; P = .02). There is no statistical difference of adverse events including nausea or vomiting (RR = 0.51; 95% CI = 0.11 to 2.35; P = .38), or itching (RR = 0.69; 95% CI = 0.26 to 1.81; P = .45) between 2 groups. CONCLUSIONS Paravertebral block is effective for pain control after percutaneous nephrolithotomy.
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Affiliation(s)
- Xiaoyu Tan
- Department of Urology, The Fourth People's Hospital of Chongqing
| | - Donglin Fu
- Department of Critical Care Medicine, Chongqing General Hospital, China
| | - Wubing Feng
- Department of Urology, The Fourth People's Hospital of Chongqing
| | - Xiangqi Zheng
- Department of Urology, The Fourth People's Hospital of Chongqing
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