Renal functional outcomes are not adversely affected by selective angioembolization following percutaneous nephrolithotomy

Abstract

ObjectiveSelective angioembolization (SAE) effectively diagnoses and treats iatrogenic vascular complications following percutaneous nephrolithotomy (PCNL).MethodsWe retrospectively reviewed 1329 consecutive PCNLs and identified patients who underwent SAE following PCNL with at least 12-month follow-up. Estimated glomerular filtration rate (eGFR) was calculated for all patients preoperatively, postoperatively and at last follow-up. A 1:2 matched cohort analysis was performed.ResultsTwenty-three patients underwent SAE and matched to 46 controls. There was no statistically significant difference in preoperative, postoperative, and follow-up eGFR when comparing patients who underwent SAE and those with an uneventful course.ConclusionLong-term eGFR is comparable in patients who undergo uncomplicated PCNL and those requiring SAE.

Percutaneous Endoscopic Treatment of Complicated Delayed Bleeding Postpercutaneous Nephrolithotomy: A Novel Suggestion

“…Retroperitoneal abscess has also been reported but less frequently. 2 Colonic infarction, skin necrosis, testicular infarction, and coil migration have also been reported. 3 In some cases, a missed diagnosis of a tiny pseudoaneurysm has led to ineffective angiographic embolization.…”

“…4 Recurrent bleeding that is not a response to standard angioembolization may require reembolization, partial nephrectomy, or total nephrectomy. 2 The leading outcome of this failure is nephron loss, which may be disastrous in patients with chronic renal failure or a single kidney. Patients with chronic renal failure are prone to develop acute tubular necrosis associated with the contrast material.…”

“…Patients with chronic renal failure are prone to develop acute tubular necrosis associated with the contrast material. 2 The balloon tamponade with kaye nephrostomy is well known as treatment of intraoperation bleeding during PCNL that does not respond to simple nephrostomy insertion. Using council catheter for management of delayed hemorrhage after PCNL is a novel approach with acceptable efficacy.…”

“…Delayed bleeding usually occurs during the first 3 weeks after surgery. 1,2 Most delayed bleeding can be relieved with conservative management, but 1% of cases require intervention. 1,3 Arteriovenous fistula and arterial pseudoaneurysm are the main causes of delayed bleeding.…”

News from leading international academic urology departments

“…Vasudevan and coworkers [4] review the role of genetics in urolithiasis. Palmerola and associates [5] demonstrate that angioembolization of A-V fistulas as well as pseudoaneurysms has no significant effect on renal function. Vira and associates [6] examine multiparametric MRI as a predictor of extraprostatic extension and demonstrate some flaws in this new technology.…”