The Efficacy and Safety of Transcatheter Arterial Embolization to Treat Renal Hemorrhage after Percutaneous Nephrolithotomy.

Nan Du,Tian-Zhu Yu,Qing-Xin Liu,Rong Liu,Zi-Han Zhang,Jian-Jun Luo,Min-Jie Yang,Jing-Qin Ma,Wen Zhang,Yun Tao,Zhi-Ping Yan

doi:10.1155/2019/6265183

Abstract

Purpose The aim of this study was to evaluate the safety and efficacy of transcatheter arterial embolization (TAE) in patients with renal hemorrhage after percutaneous nephrolithotomy (PCNL) and evaluate the risk factors that may result in severe bleeding requiring TAE. Methods We retrospectively reviewed 121 patients with post-PCNL renal hemorrhage. Thirty-two patients receiving endovascular embolization were compared with 89 patients only receiving conservative treatment. The demographic and clinical data were recorded and compared between the two groups. The values of estimated glomerular filtration rate (eGFR) and serum creatinine (SCr) were recorded preoperatively, postoperatively, and at last follow-up and analyzed to evaluate the safety and efficiency of TAE. Results The successful hemostasis rate of conservative therapy was 73.6% (89/121) and that of TAE was 100% (32/32). SCr and eGFR were not significantly different before PCNL and after the last follow-up of TAE (SCr: 0.95 vs. 0.95 mg/dl, P=0.857; eGFR: 86.77 vs. 86.18 ml/min/1.73m2, P=0.715). The univariate analysis demonstrated that advanced age, urinary tract infection, and diabetes mellitus were significantly associated with severe bleeding during PCNL. Multivariate analysis further identified that diabetes mellitus was an independent risk factor for severe bleeding needing TAE [odds ratio (OR): 3.778, 95% confidence interval (CI):1.276-11.190, and P=0.016]. Conclusion TAE is a safe and effective procedure to treat renal hemorrhage that cannot be resisted by conservative treatment after PCNL. Diabetes mellitus was associated with high risks of severe bleeding needing TAE after PCNL.

Highlights

Percutaneous nephrolithotomy (PCNL) is a safe and effective treatment for patients with upper urinary calculi
If bleeding persisted, selective renal arteriography with embolization was used to stop the bleeding
Univariate analysis indicated that advanced age (P=0.039), preoperative urinary tract infection (P=0.024), and diabetes mellitus needing embolization (P=0.001) were associated with severe postoperative bleeding

Summary

Introduction

Percutaneous nephrolithotomy (PCNL) is a safe and effective treatment for patients with upper urinary calculi. Transcatheter arterial embolization (TAE) has been regarded as an effective method for postoperative hemorrhage of PCNL [7, 9]. Patients often undergo conservative treatment to hemostasis, including nephrostomy tube clamping, adequate hydration, hemostatic drug using, and blood transfusion [10,11,12]. Patients with hemodynamic instability or refractory bleeding who cannot achieve hemostasis by conservative therapy have been recommended to angiographic embolization for diagnosis and treatment [11, 13]. The efficacy of TAE for postPCNL hemorrhage has been previously explored [11, 14], the long-term effects on renal function remain to be further confirmed. Existing studies have not directly compared patients undergoing TAE with patients only receiving conservative treatment. The purpose of this study was to evaluate the safety and efficacy of TAE for patients with

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Discussion

Conclusion