Objective: To evaluate the vascular complications of percutaneous nephrolithotomy (PCNL) patients who have undergone previous open surgery, PCNL and extracorporeal shock wave lithotripsy (ESWL). Patients and Methods: 360 patients who underwent a PCNL procedure were included into the study. The patients were divided into 4 groups: group 1: primary PCNL (n = 232); group 2: previous open nephrolithotomy (n = 42); group 3: previous PCNL (n = 33); group 4: previous ESWL (n = 63). The periods of operation and fluoroscopy use of the groups were compared in terms of residual stones, with haematuria, pre-operation and post-operation first-day haemoglobin values. Patients with persistent haematuria were assessed through ultrasonography (US), Doppler US, computed tomography and angiography. Results: Upon comparison of the patients' pre- and post-operative haemoglobin changes, haemoglobin was statistically higher in the previous open operation group than the others (p = 0.02). Permanent and intermittent haematuria were detected in 12 (3%) and 7 patients (1%), respectively. Angiography was done in 7 (1.94%) patients. This rate was 9.5% for group 2 and 3% for group 3. These rates were found to be statistically higher than compared to the other groups. Arteriovenous fistula (AVF) was detected in 4 of these patients and pseudoaneurysm in 1. While 1 of the patients with AVF improved spontaneously, embolisation was applied to 4 patients. Four of the patients had had a previous open operation, while 1 had had a PCNL treatment. Conclusions: Vascular complication is a rare complication of PCNL that can be successfully managed with angioembolisation. Our results indicate that previous open surgery significantly predicted the occurrence of these lesions.

Keywords:
Haemorrhage, Open surgery, Percutaneous nephrolithotomy, Vascular complications
1.
Fernstrom I, Johansson B: Percutaneous pyelolithotomy: a new extraction technique. Scand J Urol Nephrol 1976;10:257-259.
2.
Preminger GM, Assimos DG, Lingeman JE, et al; AUA Nephrolithiasis Guideline Panel: Chapter 1: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol 2005;173:1991-2000.
3.
Labate G, Modi P, Timoney A, et al; on behalf of the CROES PCNL Study Group J: The percutaneous nephrolithotomy global study: classification of complications. J Endourol 2011;25:1275-1280.
4.
Segura JW, Patterson DE, LeRoy AJ, et al: Percutaneous removal of kidney stones: review of 1,000 cases. J Urol 1985;134:1077-1081.
5.
Srivastava A, Singh KJ, Suri A, et al: Vascular complications after percutaneous nephrolithotomy: are there any predictive factors? Urology 2005;66:38-40.
6.
Martin X, Murat FJ, Feitosa LC, et al: Severe bleeding after nephrolithotomy: results of hyperselective embolization. Eur Urol 2000;37:136-139.
7.
Keoghane SR, Cetti RJ, Rogers AE, Walmsley BH: Blood transfusion, embolisation and nephrectomy after percutaneous nephrolithotomy (PCNL). BJU Int 2013;111:628-632.
8.
Yuruk E, Tefekli A, Sari E, et al: Does previous extracorporeal shock wave lithotripsy affect the performance and outcome of percutaneous nephrolithotomy? J Urol 2009;181:663-667.
9.
Guohua Z, Zhong W, Li X, et al: Minimally invasive percutaneous nephrolithotomy for staghorn calculi: a novel single session approach via multiple 14-18Fr tracts. Surg Laparosc Endosc Percutan Tech 2007;17:124-128.
10.
Hegarty NJ, Desai MM: Percutaneous nephrolithotomy requiring multiple tracts: comparison of morbidity with single-tract procedures. J Endourol 2006;20:753-760.
11.
Singla M, Srivastava A, Kapoor R, et al: Aggressive approach to staghorn calculi - safety and efficacy of multiple tracts percutaneous nephrolithotomy. Urology 2008;71:1039-1042.
12.
Martin X, Tajra LC, Gelet A, et al: Complete staghorn stones: percutaneous approach using one or multiple percutaneous accesses. J Endourol 1999;13:367-368.
13.
De Sio M, Autorino R, Quarto G: Modified supine versus prone position in percutaneous nephrolithotomy for renal stones treatable with a single percutaneous access: a prospective randomized trial. Eur Urol 2008;54:196-203.
14.
de la Rosette J, Assimos D, Desai M, et al; CROES PCNL Study Group: The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients. J Endourol 2011;25:11-17.
© 2013 S. Karger AG, Basel
2013
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.