Document Detail


Failure of Initial Renal Arterial Embolization for Severe Post-Percutaneous Nephrolithotomy Hemorrhage: A Multi-center Study of Risk Factors.
MedLine Citation:
PMID:  23831314     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE: Severe hemorrhage following percutaneous nephrolithotomy (PCNL) is an uncommon but alarming event. If local tamponade failed to control the bleeding, currently the treatment of choice is superselective renal arterial embolization (SRAE). If the initial SRAE is unsuccessful, repeat SRAE or nephrectomy often required. The present study is the first to investigate the risk factors for failed initial SRAE.
MATERIALS AND METHODS: From January 2007 to April 2012, a total of 17619 patients who underwent 19185 PCNL procedures in 6 centers were retrospectively reviewed. Inclusion criteria were patients who underwent PCNL and experienced severe postoperative renal hemorrhage requiring SRAE. Data on patients who failed initial SRAE were compared to patients with successful initial SRAE using univariateand multivariate analysis.
RESULTS: 117 patients (0.6%), 90 males and 27 females, met the inclusion criteria. Among them twelve patients (10.3%) failed initial treatment. Eight patients received second SRAE, 3 patients required 3 SRAE, and 1 had nephrectomy. All of the 11 repeat SRAE patients achieved complete cessation of bleeding.Three risk factors for failure of initial SRAE were identified: multiple percutaneous accesses, more than 2 bleeding sites identified during renal angiography and using gelatin sponge alone as the embolic material.
CONCLUSIONS: Careful selection of patients for multi-tract PCNL, take extra effort to identify all bleeding vessels during angiography and avoid using gelatin sponge as the only embolic material could potentially reduce the risk of failure of initial SRAE following PCNL.
Authors:
Guohua Zeng; Zhenhua Zhao; Shawpong Wan; Sanjay Khadgi; Yongfu Long; Yonghai Zhang; Guocan Cao; Xiaoming Yang
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-7-2
Journal Detail:
Title:  The Journal of urology     Volume:  -     ISSN:  1527-3792     ISO Abbreviation:  J. Urol.     Publication Date:  2013 Jul 
Date Detail:
Created Date:  2013-7-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Urology, Minimally Invasive Surgery Center,The First Affiliated Hospital of Guangzhou Medical University;Guangdong Key Laboratory of Urology. Guangdong, China. Electronic address: gzgyzgh@vip.tom.com.
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