Abstract
Percutaneous nephrolithotomy (PCNL) was reported to cause fewer complications and to reduce the length of hospital stay compared with anatrophic nephrolithotomy. Percutaneous nephrolithotomy does carry a risk of significant morbidity. Moreover, perioperative renal bleeding is one of the most common and worrisome complications of PCNL. Furthermore, delayed renal bleeding seems to be a serious complication. Various factors can increase the risk of bleeding. Delayed renal bleeding after PCNL can be managed successfully by conservative therapy. This is a retrospective analysis of patients who underwent PCNL. The aim of this study was to evaluate risk factors for development of delayed renal bleeding following PCNL and evaluation of the role of conservative management of that bleeding. The study included fifty patients who underwent PCNL inside and outside Iraq and were admitted to urology ward at Basrah General Hospital between February 2010 to May 2013. Average age of patients was 45 year. The patients were 40 males and 10 females. They presented with gross hematuria and anemia in the days following PCNL. The presentation varied between 7 up to 14 days following surgery. The patients were admitted to the emergency ward at our hospital and immediate and prompt evaluation and resuscitation was initiated. Forty five (90%) patients received blood transfusion. Forty seven (94%) patients were successfully managed with conservative treatment and the hematuria resolved. The average stay in the hospital was 5 days. Three patients (6%) needed surgical intervention. The complication rate of PCNL is up to 83%, but they are generally minor complications. Renal hemorrhage requiring intervention is a rare complication of PCNL, and its frequency is 0.6– 1.4%. The bleeding risk was significantly correlated with factors such as renal cortical thickness, location and size of renal stones and the severity of hydronephrosis prior to PCNL. Only minority of patients failed to respond to conservative measures and they needed open surgical exploration which ended with a decision for nehprectomy. Conclusion: Although PCNL is a safe procedure for the treatment of renal calculus, it sometimes results in some complications. Bleeding after PCNL can be treated with conservative measures. However, it is important to determine the time for emergent intervention. It is important to be aware about factors that increase the risk of bleeding.
Highlights
Since the first report of the removal of renal stones via nephrostomy by Rupel and Brown[1] in 1941, there have been significant improvements in techniques, instruments, and experience.Fernastrom and Johansson first reported percutaneous nephrolithotomy (PCNL) in 19762, and Alken et al[3] introduced the renal endoscope and ultrasonic lithotripsy to further the development of the technique
PCNL is recommended for cases with stones larger than 2 cm, cases with struvite or cystine stones, cases in which stone removal failed with extracorporeal shock wave lithotripsy (ESWL), or cases accompanied by anatomical malformation[4,5]
Thirty three (66%) patients who presented with severe bleeding had no or mild hydronephrosis prior to PCNL surgery
Summary
Since the first report of the removal of renal stones via nephrostomy by Rupel and Brown[1] in 1941, there have been significant improvements in techniques, instruments, and experience. Fernastrom and Johansson first reported percutaneous nephrolithotomy (PCNL) in 19762, and Alken et al[3] introduced the renal endoscope and ultrasonic lithotripsy to further the development of the technique. Extracorporeal shock wave lithotripsy (ESWL) and flexible ureteroscopic stone removal are widely used treatment modalities for renal stones, PCNL is still needed for selected cases according to the size, position, shape, and composition of the stones[3]. PCNL does carry a risk of significant morbidity; with contemporary series describing a complication rate of 20.5 %6 and transfusion rates varying enormously between less than 1% and 55 %7-11
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