Predictive factors of delayed bleeding after percutaneous nephrolithotomy requiring angioembolization

Irani, Dariush; Haghpanah, Abdolreza; Rasekhi, Alireza; Kamran, Hooman; Rahmanian, Mahdi; Hosseini, Mohammad Mehdi; Dejman, Behnam; Kiani, Sajad

doi:10.1002/bco2.272

Cited by 3 publications

(1 citation statement)

References 32 publications

(77 reference statements)

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“…Several risk factors have been identified as having significant value in the development of hemorrhagic complications. Thus, the presence of diabetes mellitus and renal anomalies have been implicated as positive predictive factors for the occurrence of post-interventional AVF [ 30 ]. Additionally, in the same study, a history of PCNL, ESWL, arterial hypertension, gender, age, presence of coagulopathies, and volume of the lithiasis were evaluated as variables in the development of AVF, but no statistically significant causative relationship was established.…”

Section: Discussionmentioning

confidence: 99%

Arteriovenous Fistula: The Case of a Rare Complication after Minimal Percutaneous Nephrostomy and Brief Review

Dănău,

Petca,

Constantin

et al. 2024

Diagnostics

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Percutaneous renal surgery, although much less invasive than other procedures, is subject to several complications, which can occur at any time during the course of treatment, starting from the performance of the minimal nephrostomy procedure. We present an extremely rare vascular complication of percutaneous nephrostomy represented by arteriovenous fistula that occurred in a 24-year-old patient known to have right ureteropelvic junction obstruction operated with the absence of double-J catheter permeability and grade II-III hydronephrosis for which minimal percutaneous nephrostomy was urgently fitted. The arteriovenous fistula was resolved by supraselective artery embolization.

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Section: Discussionmentioning

confidence: 99%

Arteriovenous Fistula: The Case of a Rare Complication after Minimal Percutaneous Nephrostomy and Brief Review

Dănău,

Petca,

Constantin

et al. 2024

Diagnostics

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The modified 5-item frailty index as a predictor of perioperative risk in patients undergoing percutaneous nephrolithotomy

Chaker,

Ouanes,

Marrak

et al. 2024

Int Urol Nephrol

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Introduction The modified 5-item frailty index is a relatively new tool to assess the post-operative complication risks. In urology, there is limited literature on the impact of frailty on percutaneous nephrolithotomy (PCNL) outcomes. We aimed to compare the predictive value of the modified 5-item frailty index (mFI-5) to identify high risk patients prior to PCNL. Methods A database of patients undergoing PCNL, between 2015 and 2022, was analyzed. Patient frailty was assessed using the mFI-5 index. The mFI-5 index was calculated based on the presence of the five co-morbidities: congestive heart failure within 30 days prior to surgery, diabetes mellitus, chronic obstructive pulmonary disease, partially dependent or totally dependent functional health status at time of surgery, and hypertension requiring medication. Patients were grouped as not frail (mFI-5 = 0), intermediate (mFI-5 = 1), and severely frail (mFI-5 ≥ 2). Primary outcomes were 30-day postoperative complications. Secondary outcomes were hospitalization: total hospital length of stay, reoperation, and unplanned readmission. Results From a total of 320 PCNL patients included for analysis, 54.06% (n = 173) were not frail, 17.81% (n = 57) were intermediate, and 28.12% (n = 90) were severely frail. Frail patients were likely to be older (p = 0.002) and have a higher American Society of Anesthesiologists score (p = 0.001), chronic kidney disease (p < 0.001). Patients of intermediate or severe frailty were more likely to exhibit postoperative sepsis (p = 0.042), significant blood loss (p = 0.036) and require intensive care units admissions (p = 0.0015). Frail patients had a longer hospital length of stay (p < 0.001) and tended to require reoperation (p = 0.001), and unplanned readmission (p = 0.02). Conclusion Frailty assessment appears useful in stratifying those at risk of extended hospitalization, septic and hemorrhagic complications, readmission, or reoperation after PCNL. Preoperative assessment of frailty phenotype may give insight into treatment decisions and assist surgeons in counselling patients on expected course and hospital stay following PCNL.

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Severe bleeding in patients following “tubeless” percutaneous nephrolithotomy: Predictors of angioembolization

Surag,

Shah,

Vishwanath Gali

et al. 2024

Urologia

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Introduction: Percutaneous nephrolithotomy (PCNL) is a widely used procedure for treating renal calculi. Advanced techniques have improved outcomes, but hemorrhage remains a significant complication. While most cases of hemorrhagic complications are typically managed conservatively, few cases necessitate interventions like angioembolization (AE). The purpose of this study is to identify risk factors closely associated with severe bleeding post-PCNL requiring AE and to assess if these factors can independently predict the type of lesion [arteriovenous fistula (AVF) vs pseudoaneurysm (PA)]. Materials and method: A retrospective analysis was conducted on 119 patients who underwent “tubeless” PCNL and experienced severe bleeding between January 2018 and December 2023. The study reviewed demographic characteristics, stone characteristics, perioperative factors, and adverse events. The chi-square test and Fisher’s exact test were used for univariate analysis. Logistic regression analysis was used in binomial analysis with a value of p < 0.05 considered statistically significant. Results: Out of 119 patients, 51 required AE. Elevated preoperative serum creatinine levels (>1.5 mg/dl) [ p = 0.01], upper pole access [ p = 0.008], and a larger access sheath size (standard PCNL vs mini-PCNL) [ p ⩽ 0.001] were found to be significantly associated with AE. Logistic regression analysis revealed standard PCNL was significantly associated with post-PCNL bleeding requiring AE (odds ratio [OR]: 50, 95% confidence interval [CI]: 6.529–382.90, p ⩽ 0.001). Stone size and co-morbidities showed no significant association with AE. The average duration of presentation of symptoms post PCNL was 13.6 days. Most patients underwent coiling for AE, with a clinical success rate of 94%. Conclusion: Elevated serum creatinine levels, upper pole access, and tract size >24 Fr are more prone to post-tubeless PCNL severe bleeding, which requires renal AE. The findings suggest that early angiography and possible AE should be considered for at-risk patients. In the future, these predictors may be integrated into predictive models to improve patient risk stratification.

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Predictive factors of delayed bleeding after percutaneous nephrolithotomy requiring angioembolization

Cited by 3 publications

References 32 publications

Arteriovenous Fistula: The Case of a Rare Complication after Minimal Percutaneous Nephrostomy and Brief Review

Arteriovenous Fistula: The Case of a Rare Complication after Minimal Percutaneous Nephrostomy and Brief Review

The modified 5-item frailty index as a predictor of perioperative risk in patients undergoing percutaneous nephrolithotomy

Severe bleeding in patients following “tubeless” percutaneous nephrolithotomy: Predictors of angioembolization

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