Pakdel Alireza, Asgari Fardin, Bahri Razman Arabzadeh, Aghamir Seyed Mohammad Kazem
Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
J Med Case Rep. 2024 Mar 12;18(1):101. doi: 10.1186/s13256-024-04431-4.
Percutaneous nephrolithotomy is the most commonly used modality for the removal of kidney stones larger than 2 cm in size. Like other stone removal methods, percutaneous nephrolithotomy also has some complications, including bleeding and delayed hematuria. These complications are improved with conservative management and bed rest most of the time. However, it may require more invasive treatments. Angioembolization following an abnormal renal angiography is an efficient treatment modality for delayed hematuria. Furthermore, nephrectomy is suggested in uncontrolled cases of delayed hematuria when renal angiography is normal.
We described two cases of uncontrolled delayed hematuria after percutaneous nephrolithotomy and angioembolization were carried out rather than potential nephrectomies. The first case was a 61-year-old Iranian man with left kidney stones, for whom percutaneous nephrolithotomy was planned. The patient was referred to the hospital after discharge with massive hematuria and had normal angiographic findings. An angioembolization was suggested for the patient and was carried out. His hematuria was dramatically improved within 30 minutes, and his hemoglobin level started to increase 2 days later. The second case was a 53-year-old Iranian man with kidney stones who was a candidate for right kidney percutaneous nephrolithotomy. The patient was referred to the hospital 4 days after discharge with a decreased hemoglobin level and massive hematuria. The patient had normal angiographic findings and was planned for angioembolization to control his hemorrhage, which dramatically decreased after the angioembolization within 60 minutes.
Embolization of the segmental arteries of the targeted calyx can eliminate hematuria of the patient and prevent further nephrectomy.
经皮肾镜取石术是治疗直径大于2厘米肾结石最常用的方法。与其他结石清除方法一样，经皮肾镜取石术也有一些并发症，包括出血和延迟性血尿。大多数情况下，这些并发症通过保守治疗和卧床休息可得到改善。然而，可能需要更具侵入性的治疗。肾血管造影异常后进行血管栓塞是治疗延迟性血尿的有效方法。此外，当肾血管造影正常但延迟性血尿无法控制时，建议进行肾切除术。
我们描述了两例经皮肾镜取石术后延迟性血尿无法控制的病例，进行了血管栓塞而非潜在的肾切除术。第一例是一名61岁的伊朗男性，患有左肾结石，计划进行经皮肾镜取石术。患者出院后因大量血尿入院，血管造影结果正常。建议对患者进行血管栓塞并实施。其血尿在30分钟内显著改善，血红蛋白水平在2天后开始上升。第二例是一名53岁的伊朗男性，患有肾结石，是右肾经皮肾镜取石术的候选者。患者出院4天后因血红蛋白水平下降和大量血尿入院。患者血管造影结果正常，计划进行血管栓塞以控制出血，血管栓塞后60分钟内出血显著减少。
栓塞目标肾盏的节段动脉可消除患者血尿并避免进一步肾切除。
