کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
---|---|---|---|---|
6167131 | 1250312 | 2015 | 5 صفحه PDF | دانلود رایگان |
ObjectiveTo provide a contemporary look at vascular complications after percutaneous nephrolithotomy (PNL) with access performed solely by a urologist using fluoroscopic guidance.MethodsA retrospective review of 2792 patients who had 3338 PNLs at Indiana University Health Methodist Hospital and Mayo Clinic Rochester was performed. Patients who experienced significant bleeding requiring diagnostic renal angiography and superselective embolization (SSE) were reviewed and compared with the overall database.ResultsThere were 15 patients (16 renal units) requiring renal angiography and SSE (0.48%). Mean time from PNL to bleeding was 7Â days (range, 1-15Â days) and to SSE was 9.6Â days (range, 2-18Â days). Mean drop in hemoglobin was 5.3Â g/dL (range, 2-9Â g/dL). Transfusion was needed in 9 patients (60%). There were no differences between the vascular complications group and the uneventful PNL group in mean age (55.06 vs 52.2Â years; PÂ = .519), UTI history (40% vs 38%; PÂ = .92), mean operative time (125.8 vs 102.47Â minutes; PÂ = .192), the need for multiple access (18.75% vs 18%; PÂ = .939), and access location. The vascular complications group had a lower stone burden than the uneventful PNL group (stones > 2Â cm; 43.7% vs 74.03%; PÂ = .014).ConclusionThe incidence of vascular complications in this contemporary series is one of the lowest reported to date. At our centers, vascular bleeding complications appear to be a random and rare event after PNL as we were unable to identify any specific risk factors. Early SSE avoided the need for blood transfusion in many patients.
Journal: Urology - Volume 85, Issue 4, April 2015, Pages 777-781