Emergent Intervention Criterias for Controlling Sever Bleeding after Percutaneous Nephrolithotomy

Ural Oguz,Omer Faruk Bozkurt,Mirze Bayindir,Berkan Resorlu,Ali Unsal,Tolga Sahin

doi:10.1155/2013/760272

Abstract

Objectives. To determine when emergent intervention for bleeding after percutaneous nephrolithotomy (PCNL) is required. Methods. We reviewed analysis data of 850 patients who had undergone PCNL in our center. Blood transfusion was needed for 60 (7%) patients during and/or after surgery. We routinely performed followup of the urine output per hour, blood pressure, and hemoglobin levels after PCNL. Five (0.6%) of them had severe bleeding that emergent intervention was needed. Results. The mean age of the 5 patients who had emergent surgery due to severe bleeding was 42.2 (19–56) years. Mean duration of surgery was 44.75 (25–65) minutes. Mean stone size was 27 (15–38) mm. Mean decrease of hemoglobin was 4.8 (3.4–5.8) ng/dL, and unit of transfused blood was 4.4 (3–6). Mean blood pH was 7.21. There were metabolic acidosis and anuria/oliguria in all these patients. One of 5 patients suffered from cardiopulmonary arrest because of massive bleeding four hours after the PCNL, and despite cardiac resuscitation, he died. Hemorrhaging was controlled by open surgery in the other 4 patients. Two patients experienced cardiac arrest during the open surgery but they responded to cardiac resuscitation. There were no metabolic asidosis and anuria/oliguria, and bleeding was managed only with blood transfusion for the other 55 patients. Conclusion. Severe bleeding after PCNL is rare and can be mortal. If metabolic asidosis and anuria/oliguria accompanied the drop of hemoglobin, emergent surgical intervention should be performed because vascular collapse may follow, and it may be too difficult to stabilise the patient.

Highlights

Urolithiasis is a common disease, and the prevalence of this disease is increasing everyday [1]
If anuria or oliguria is detected, we focus on the vital signs like blood pressure, pulse, and we check the blood count and blood gas analysis for metabolic acidosis
Renal hemorrhaging requiring intervention is a rare complication of percutaneous nephrolithotomy (PCNL), and its frequency is 0.6–1.4% [6]

Summary

Introduction

Urolithiasis is a common disease, and the prevalence of this disease is increasing everyday [1]. Percutaneous nephrolithotomy (PCNL) is an effective and common treatment technique for especially large and complex renal calculi. PCNL is a common procedure, it can be associated with some mortal or morbid complications such as septicemia, severe bleeding, and pleural or colonic injury. We documented patients who needed blood transfusion and patients who had renal hemorrhaging requiring emergent intervention after PCNL. We aimed to answer questions including “how long conservative therapy for bleeding after PCNL takes?” and “when emergent intervention should be performed?” To our knowledge, this is the first paper to investigate this topic regarding PCNL

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Conclusion