Severe bleeding after nephrolithotomy: Results of hyperselective embolization

From 1984 to 1998, 808 patients underwent percutaneous nephrolithotomy for removal of renal calculi, Although the technique is safe and effective, com plications, including hemorrhages, have been reported. Eight patients (1%) are described in whom severe bleeding following percutaneous nephrolithotom y was uncontrolled by usual methods and treated by hyperselective embolizat ion, Renal arteriography has shown arteriovenous fistula in 3 patients, pse udo aneurysm in 4 and both in 1 patient. Embolization allowed definitive tr eatment of these lesions in 7 of our 8 patients. The failure of embolizatio n in 1 patient imposed a partial nephrectomy. Patients with normal renal fu nction did not suffer significant change in the serum creatinine after trea tment (percutaneous nephrolithotomy + embolization), and all but 1 patient have maintained normal blood pressure, In the authors' opinion, hyperselect ive embolization is the least invasive and best treatment for massive hemor rhage after percutaneous nephrolithotomy. Copyright (C) 2000 S. Karger AG, Basel.