Management of Bleeding Complications after Percutaneous Nephrolithotripsy: A Single-Center Experience

Background: Hemorrhage is the most common and dangerous complication after percutaneous nephrolithotripsy (PCNL). Therefore, this study introduces the management experience of bleeding complications in our center.

Methods: This retrospective study included 77 patients with severe bleeding after PCNL. Forty patients were included in the conservative group, 13 in the transfusion group, and 24 in the embolization group. The characteristics of postoperative bleeding were analyzed, including changes in hemoglobin and hematocrit, bleeding inducement, bleeding management, and clinical results.

Results: Forty patients received conservative treatment. Their mean hemorrhage time was 6.5 days (range, 3-14 days), and their mean decreased hemoglobin was 33.8 g/L (range, 13-61 g/L). Thirteen patients received only conservative treatment and blood transfusions. Their mean hemorrhage time was 11 days (range, 2-17 days), and their mean decreased hemoglobin was 49 g/L (range, 25-85 g/L). Twenty-four patients required renal angiography and renal artery embolization (RAE). Their average time from PCNL to RAE was 11 days (range, 3-25 days). Hemoglobin levels decreased by an average of 52.8 g/L (range, 19-89 g/L). A decrease in hematocrit ≥14.65% was a significant indicator for post-PCNL RAE.

Conclusions: A decreased hemoglobin level can be used as a reference for decisions regarding embolization; However, it should not be used as an absolute criterion. Conservative treatment and embolization are effective for achieving hemostasis. Appropriate treatment methods should be comprehensively determined based on clinical manifestations, bleeding inducement, and blood index changes.