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Superselective renal arterial embolization for severe postpercutaneous nephrolithotomy haemorrhage: clinical characteristics and risk factors for initial failure

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Abstract

Objective

To identify the clinical characteristics of patients who underwent superselective renal arterial embolization (SRAE) after percutaneous nephrolithotomy (PCNL) and to explore the risk factors for failed initial SRAE after PCNL.

Materials and methods

Patients who underwent SRAE for severe haemorrhage following PCNL between January 2014 and December 2020 were included in the study. The clinical data of those patients and the parameters and characteristics of the perioperative PCNL and SRAE procedures were collected and analysed.

Results

A total of 243 patients were included in this study. A total of 139 patients (57.2%) had a pseudoaneurysm, 25 (10.3%) had an arteriovenous fistula, 50 (20.6%) patients had both a pseudoaneurysm and an arteriovenous fistula, and 29 (11.9%) had an arterial laceration. In 177 patients with single percutaneous access, 125 (70.6%) patients exhibited nontract haemorrhage, and 55 (31.1%) patients exhibited multiple bleeding sites. In 66 patients with multiple percutaneous access, 44 (66.7%) patients exhibited nontract haemorrhage, and 32 (48.5%) patients exhibited multiple bleeding sites. The decrease in Hb before SRAE was 41.4 ± 19.8 g/L. The mean time between PCNL surgery and initial SRAE was 6.4 ± 4.9 days. Serum creatinine was increased after the SRAE procedure. Initial SRAE was successful in 229 (94.2%) patients and failed in 14 (5.8%) patients. Multivariate regression demonstrated that hydronephrosis < 20 mm, total ultrasonographic guidance, solitary kidney, previous ipsilateral renal surgery, PCNL duration > 90 min and multiple bleeding sites were potential risk factors for initial embolization failure.

Conclusion

Percutaneous access was not the most important reason for post-PCNL severe haemorrhage. SRAE is effective for the treatment of severe haemorrhage following PCNL; however, several factors have an impact on the success of initial SRAE. Additionally, the SRAE procedure may affect renal function.

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Data availability

The data of the current study can not be available.

References

  1. Scales CD Jr, Smith AC, Hanley JM, Saigal CS (2012) Prevalence of kidney stones in the United States. Eur Urol 62(1):160–165

    Article  PubMed  PubMed Central  Google Scholar 

  2. Zeng G, Mai Z, Xia S et al (2017) Prevalence of kidney stones in China: an ultrasonography based cross-sectional study. BJU Int 120(1):109–116

    Article  PubMed  Google Scholar 

  3. Türk C, Petřík A, Sarica K et al (2016) EAU guidelines on interventional treatment for urolithiasis. Eur Urol 69(3):475–482

    Article  PubMed  Google Scholar 

  4. Martin X, Murat FJ, Feitosa LC et al (2000) Severe bleeding after nephrolithotomy: results of hyperselective embolization. Eur Urol 37(2):136–139

    Article  CAS  PubMed  Google Scholar 

  5. Kyriazis I, Panagopoulos V, Kallidonis P, Özsoy M, Vasilas M, Liatsikos E (2015) Complications in percutaneous nephrolithotomy. World J Urol 33(8):1069–1077

    Article  PubMed  Google Scholar 

  6. Bookstein JJ, Ernst CB (1973) Vasodilatory and vasoconstrictive pharmacoangiographic manipulation of renal collateral flow. Radiology 108(1):55–59

    Article  CAS  PubMed  Google Scholar 

  7. Chuang VP, Reuter SR, Walter J, Foley WD, Bookstein JJ (1975) Control of renal hemorrhage by selective arterial embolization. Am J Roentgenol Radium Ther Nucl Med 125(2):300–306

    Article  CAS  PubMed  Google Scholar 

  8. Vignali C, Lonzi S, Bargellini I et al (2004) Vascular injuries after percutaneous renal procedures: treatment by transcatheter embolization. Eur Radiol 14(4):723–729

    Article  PubMed  Google Scholar 

  9. El-Nahas AR, Shokeir AA, El-Assmy AM et al (2007) Post-percutaneous nephrolithotomy extensive hemorrhage: a study of risk factors. J Urol 177(2):576–579

    Article  PubMed  Google Scholar 

  10. Zeng G, Zhao Z, Wan S et al (2013) Failure of initial renal arterial embolization for severe post-percutaneous nephrolithotomy hemorrhage: a multicenter study of risk factors. J Urol 190(6):2133–2138

    Article  PubMed  Google Scholar 

  11. Mao Q, Wang C, Chen G, Tan F, Shen B (2019) Failure of initial superselective renal arterial embolization in the treatment of renal hemorrhage after percutaneous nephrolithotomy: a respective analysis of risk factors. Exp Ther Med 18(5):4151–4156

    PubMed  PubMed Central  Google Scholar 

  12. Zeng G, Zhao Z, Wan S et al (2013) Minimally invasive percutaneous nephrolithotomy for simple and complex renal caliceal stones: a comparative analysis of more than 10,000 cases. J Endourol 27(10):1203–1208

    Article  PubMed  PubMed Central  Google Scholar 

  13. Zeng G, Mai Z, Zhao Z et al (2013) Treatment of upper urinary calculi with Chinese minimally invasive percutaneous nephrolithotomy: a single-center experience with 12,482 consecutive patients over 20 years. Urolithiasis 41(3):225–229

    Article  PubMed  Google Scholar 

  14. Zeng G, Zhong W, Pearle M, et al (2021) European Association of Urology Section of Urolithiasis and International Alliance of Urolithiasis Joint Consensus on Percutaneous Nephrolithotomy. Eur Urol Focus

  15. Sampaio FJ, Aragao AH (1990) Anatomical relationship between the intrarenal arteries and the kidney collecting system. J Urol 143(4):679–681

    Article  CAS  PubMed  Google Scholar 

  16. Miller NL, Matlaga BR, Lingeman JE (2007) Techniques for fluoroscopic percutaneous renal access. J Urol 178(1):15–23

    Article  PubMed  Google Scholar 

  17. Kallidonis P, Kyriazis I, Kotsiris D, Koutava A, Kamal W, Liatsikos E (2017) Papillary vs nonpapillary puncture in percutaneous nephrolithotomy: a prospective randomized trial. J Endourol 31(S1):S4–S9

    Article  PubMed  Google Scholar 

  18. Ran R, Zhang R, Xie Y, Yin Z (2021) Decreased hemoglobin as a quantifiable indicator of renal arterial embolization in post-percutaneous nephrolithotomy hemorrhage. Urolithiasis 49(2):137–143

    Article  PubMed  Google Scholar 

  19. Sampaio FJ, Zanier JF, Aragão AH, Favorito LA (1992) Intrarenal access: 3-dimensional anatomical study. J Urol 148(6):1769–1773

    Article  CAS  PubMed  Google Scholar 

  20. Senocak C, Ozbek R, Bozkurt OF, Unsal A (2018) Predictive factors of bleeding among pediatric patients undergoing percutaneous nephrolithotomy. Urolithiasis 46(4):383–389

    Article  PubMed  Google Scholar 

  21. Kim HY, Lee KW, Lee DS (2020) Critical causes in severe bleeding requiring angioembolization after percutaneous nephrolithotomy. BMC Urol 20(1):22

    Article  PubMed  PubMed Central  Google Scholar 

  22. Park S, Pearle MS (2006) Imaging for percutaneous renal access and management of renal calculi. Urol Clin N Am 33(3):353–364

    Article  Google Scholar 

  23. Zhu W, Li J, Yuan J et al (2017) A prospective and randomised trial comparing fluoroscopic, total ultrasonographic, and combined guidance for renal access in mini-percutaneous nephrolithotomy. BJU Int 119(4):612–618

    Article  PubMed  Google Scholar 

  24. Jinga V, Dorobat B, Youssef S et al (2013) Transarterial embolization of renal vascular lesions after percutaneous nephrolithotomy. Chirurgia (Bucur) 108(4):521–529

    CAS  PubMed  Google Scholar 

  25. Meng X, Bao J, Mi Q, Fang S (2019) The analysis of risk factors for hemorrhage associated with minimally invasive percutaneous nephrolithotomy. Biomed Res Int 2019:8619460

    Article  PubMed  PubMed Central  Google Scholar 

  26. Yesil S, Ozturk U, Goktug HN, Tuygun C, Nalbant I, Imamoglu MA (2013) Previous open renal surgery increased vascular complications in percutaneous nephrolithotomy (PCNL) compared with primary and secondary PCNL and extracorporeal shock wave lithotripsy patients: a retrospective study. Urol Int 91(3):331–334

    Article  PubMed  Google Scholar 

  27. Wang M, Zhang J, Xing N (2016) Rupture of ectopic renal arterial pseudoaneurysm after percutaneous nephrolithotomy. Int Braz J Urol 42(4):845–847

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Li L, Zhang Y, Chen Y et al (2015) A multicentre retrospective study of transcatheter angiographic embolization in the treatment of delayed haemorrhage after percutaneous nephrolithotomy. Eur Radiol 25(4):1140–1147

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by The National Natural Science Foundation of China (no. 82070719) and the Science and Technology Planning Project of Guangzhou City, China (nos. 20210201040212; 202002030042; 202201020420).

Author information

Author notes

  1. Tao Zeng, Weizhou Wu and Liangwei Zhang: contributed equally to this work as the co-first authors.

Authors and Affiliations

  1. Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China

    Tao Zeng, Weizhou Wu, Liangwei Zhang, Shike Zhang, Yapeng Huang, Zhican He, Zhenglin Chang, Wen Zhong, Guohua Zeng & Wenqi Wu

  2. Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China

    Tao Zeng, Weizhou Wu, Liangwei Zhang, Shike Zhang, Yapeng Huang, Zhican He, Zhenglin Chang, Wen Zhong, Guohua Zeng & Wenqi Wu

  3. Department of Urology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China

    Shike Zhang, Zhican He & Wenqi Wu

  4. Department of Urology, Maoming People’s Hospital, Maoming, Guangdong, China

    Weizhou Wu

  5. Department of Urology, People’s Hospital of Yingde City, Qingyuan, Guangdong, China

    Liangwei Zhang

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  1. Tao Zeng
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Contributions

TZ: protocol/project development, data collection or management, data analysis, manuscript writing/editing. WW: data collection or management, data analysis. LZ: data collection or management, data analysis. SZ: data collection or management. YH: data collection or management. ZH: data collection or management. ZC: data collection or management. WZ: manuscript writing/editing. GZ: protocol/project development, manuscript writing/editing. WW: protocol/project development, manuscript writing/editing.

Corresponding authors

Correspondence to Guohua Zeng or Wenqi Wu.

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Zeng, T., Wu, W., Zhang, L. et al. Superselective renal arterial embolization for severe postpercutaneous nephrolithotomy haemorrhage: clinical characteristics and risk factors for initial failure. World J Urol 41, 1647–1652 (2023). https://doi.org/10.1007/s00345-023-04391-2

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  • DOI: https://doi.org/10.1007/s00345-023-04391-2

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