SRAE effective for treatment of severe haemorrhage following PCNL

The latest research shows that super selective renal arterial embolization is successful in treating severe hemorrhage following PCNL. However, certain factors like hydronephrosis <20 mm, previous ipsilateral renal surgery, multiple bleeding sites, PCNL duration >90 min, solitary kidney, and total ultrasonographic guidance were considered significant risk factors for first embolization failure. 

The treatment of significant bleeding after percutaneous nephrolithotomy (PCNL) is super selective renal arterial embolization (SRAE). But, there is still a sizable percentage of failures necessitating another SRAE or nephrectomy. Hence researchers conducted a study to identify the clinical characteristics of patients who underwent super selective renal arterial embolization (SRAE) after percutaneous nephrolithotomy (PCNL) and to explore the risk factors for failed initial SRAE after PCNL. 

The research comprised of patients who underwent SRAE for severe hemorrhage following PCNL between January 2014 and December 2020. Analysis of the clinical data of the participants, their parameters, and characteristics of the perioperative PCNL and SRAE procedures were collected and analyzed.

Key findings: 

• 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 hemorrhage, and 55 (31.1%) patients exhibited multiple bleeding sites.
• In 66 patients with multiple percutaneous access, 44 (66.7%) patients exhibited nontract hemorrhage, 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.
• 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 as per multivariate regression analysis. 

Thus, the primary cause of the significant hemorrhage that occurred after PCNL was not percutaneous access. SRAE is successful when treating severe hemorrhage after PCNL, however, several variables can affect how well the first SRAE works. 

Further reading: Zeng T, Wu W, Zhang L, et al. Superselective renal arterial embolization for severe postpercutaneous nephrolithotomy hemorrhage: clinical characteristics and risk factors for initial failure [published online ahead of print, 2023 Apr 8]. World J Urol. 2023;10.1007/s00345-023-04391-2. doi: 10.1007/s00345-023-04391-2