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

Delayed bleeding after percutaneous nephrolithotomy (PCNL), which may occur within the first 3 weeks postoperatively, is a life-threatening complication that may result from arteriovenous fistula and arterial pseudoaneurysm. Angioembolization is the standard treatment when these patients develop hemodynamic instability despite conservative measures. Contrast hypersensitivity and renal insufficiency, however, contraindicate angiogram and subsequent embolization; in these patients, alternative methods such as the one described in this study may help in resolving the renal hemorrhage. In this case series, we report the effective management of post-PCNL hemorrhage with nephroscopy and nephrostomy and drainage and tamponade because angioembolization was not feasible. Delayed bleeding after PCNL may be managed conservatively with nephrostomy drainage and tamponade when angioembolization is not feasible.