[Interventional treatment of massive hemorrhage after percutaneous nephrolithotomy].

OBJECTIVE

To explore the diagnostic and therapeutic measures of massive hemorrhage after percutaneous nephrolithotomy (PCNL) unresponsive to conservative treatment.

METHODS

The clinical data of 36 cases of massive hemorrhage occurring after PCNL from January 2010 to January 2014 at our hospital were analyzed. There were 21 males and 15 females with an average age of 46.7 years. There were left (n = 22) and right (n = 14) cases. Severe hemorrhage had an average onset of Days 3-4 (range, 1 to 7) after PCNL. Clinical manifestations included a drainage of fresh red blood liquids out of kidney fistula accompanied by red gross hematuria. Conservative measures were ineffective.

RESULTS

On computed tomography angiography (CTA), pseudoaneurysm (n = 22) and arteriovenous fistula (n = 5) were found. Digital subtraction angiography (DSA) and coil embolization were successfully performed in 27 cases whose hemorrhage stopped in 1-3 days after embolization and kidney function returned to normal. Another 9 cases had no obvious hemorrhage on CTA. And venous hemorrhage was considered and conservative treatment succeeded.

CONCLUSIONS

Renal arterial CTA is an ideal for assessing massive hemorrhage after PCNL unresponsive to conservative treatment. DSA and coil embolization are the preferred treatments.