MANAGEMENT OF HEMORRHAGE AFTER PERCUTANEOUS RENAL SURGERY

Renal hemorrhage is the most worrisome complication of percutaneous re nal surgery. Between August 1983 and August 1992 we performed 2,200 pe rcutaneous renal operations, with 17 patients (0.8%) requiring angiogr aphy and embolization for significant bleeding uncontrolled by the usu al measures. The angiographic diagnoses were arteriovenous fistula in 7 patients, pseudoaneurysm in 4, fistula and pseudoaneurysm in 2, and lacerated renal vessels in 2. A total of 15 patients required no furth er treatment after embolization, while 2 underwent either partial neph rectomy or open exploration. No risk factors for hemorrhage could be i dentified. We recommend angiography and embolization under 3 condition s: 1) in the immediate postoperative period when clamping of the nephr ostomy tube and a tamponade balloon catheter fail to control hemorrhag e (24% of our series), 2) in the early postoperative period (2 to 7 da ys) when the patient requires 3 or 4 units of blood after replacement of the initial blood loss (41% of our series) and 3) for sudden hemorr hage more than 7 days postoperatively (35% of our series).