Abstract
To determine quantifiable indicators for post-percutaneous nephrolithotomy (PCNL) renal arterial embolization. A total of 2043 patients who underwent PCNL from September 2012 to March 2018 were reviewed retrospectively. Post-operative hemorrhage patients were extracted and divided into two groups according to treatment methods (conservative methods or super-selective renal arterial embolization [SRAE]). Demographic characteristics and hemorrhage outcomes were compared between the two groups by univariable analysis. Multivariable logistic regression was used to reveal the association between hemorrhage outcome factors and SRAE. A receiver operating characteristic (ROC) curve was drawn to determine the optimized cut-off value for SRAE. We identified 71 patients who had post-PCNL hemorrhage. Seventeen and 54 patients comprised the SRAE and conservative groups, respectively. No significant differences in demographic characteristics were found between the two groups. Univariate analysis showed that the differences in decreased hemoglobin (Hb), hemorrhage types, and transfusion were significant between the two groups (p < 0.001). Multivariable analysis showed that the decreased Hb was closely associated with the risk of SRAE. The ROC curve showed that an adjusted Hb decrease of 3.45 g/dL was an optimum indicator (AUC = 0.925). Decreased Hb is an indicator for SRAE after PCNL. When the adjusted decrease in Hb is ≥ 3.45 g/dL, SRAE should be performed regardless of the manifestations of hemorrhage.
Highlights
Percutaneous nephrolithotomy (PCNL), the first-line treatment for large or complex renal stones, was initially reported by Fernstrom and Johansson in 1976 [1]
Selective renal angiographic embolization (SRAE) is a high-efficiency, mini-invasive procedure which is recognized as the treatment of choice for post-PCNL hemorrhage
Seventy-one patients were included in our study based on the above criteria and were divided into two groups according to treatment methods, and all patients with hemorrhage included in our study were hemodynamically stable
Summary
Percutaneous nephrolithotomy (PCNL), the first-line treatment for large or complex renal stones, was initially reported by Fernstrom and Johansson in 1976 [1]. This procedure offers high stone-free rates and a short recovery time [2]; post-PCNL complications are not completely avoidable [3]. The severity of bleeding can be an indication for angioembolization. Several studies have proposed that an Hb decrease > 3 g/dL while undergoing transfusions is an accepted indication for angioembolization in different surgical conditions [11,12,13,14], but there are few studies which have focused on establishing
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