Same-day angiography and embolization in delayed hematuria following percutaneous nephrolithotomy: an effective, safe, and time-saving approach

Abstract

Purpose

To evaluate the results of prompt, same-day selective angiography and transcatheter angioembolization (TAE) on delayed post-percutaneous nephrolithotomy (PCNL) hematuria.

Materials and methods

Between 2011 and 2017, 21 patients with a mean age of 37 years (range, 21–60 years; males, 18) underwent digital subtraction angiography (DSA) and TAE to control delayed gross hematuria following PCNL. Discharged patients who following an uneventful PCNL presented to the emergency room with gross, brisk hematuria were included in the study and taken up for prompt, same-day DSA and same-session TAE with N-butyl-2-cyanoacrylate glue, without resorting to any initial conservative measures. All patient data were retrieved from medical records.

Results

Angiography revealed vascular lesions in all the cases (pseudoaneurysms, 14 cases; arteriovenous fistula, 2; mixed lesions, 5). The mean time of onset of delayed hemorrhage was 10.10±2.67 days. The average time from onset of bleeding to TAE was 4.31±0.64 hours (range 3.5–5.5 hours). Bleeding was controlled in all the cases without any recurrence or the need for further embolization. There were no procedural complications except for transient elevation of serum creatinine in four cases.

Conclusion

Primary DSA and TAE is a safe, effective, and time-saving alternative to conservative management for post-PCNL, delayed, gross hematuria.

Keywords:

• angiography
• transcatheter angioembolization
• PCNL
• hematuria
• delayed bleeding
• percutaneous nephrostomy

Supplementary materials

Table S1 Demographic and primary treatment (PCNL) and TAE characteristics (n=21)

Table S2 Hemoglobin and creatinine levels (mean±SD, 95% CI) (n=21)

Table S3 Incidence of vascular lesions on angiography (n=21)

Author contributions

All authors contributed to data analysis, drafting and revising the article, gave final approval of the version to be published and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.