Presented by: Charan Mohan
The Smith Institute for Urology, Northwell Health

Introduction

Severe bleeding following percutaneous nephrolithotomy (PCNL) is a complication that has significant impact on morbidity, readmissions and length of stay. This study seeks to describe the true incidence of severe bleeding related complications following PCNL and identify risk factors that may help predict the need for intervention

Materials

A retrospective data query was performed for all PCNL’s performed over an 18-month period (6/2020 to 12/2021) across a large health system. Analysis included all patients requiring angiography with or without embolization. Patient, surgeon, and procedure specific details were analyzed to examine any predictors of severe bleeding complications requiring intervention.

Results

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A total of 778 surgeries were identified across 9 different hospitals. The median age was 61 (IQR 50-69) and median length of stay was 1 day (IQR 1-3). 12 patients had bleeding requiring angiography (1.5%), performed at a median time of POD4. Only 7 patients (0.9%) required embolization with 5 due to pseudoaneurysm, and 2 for injured renal vasculature. There was no patient factor which predicted which patients undergoing angiography would need embolization (Table 1). .  Patients who needed embolization had higher rates of pre-operative anticoagulation use compared to all non-embolized PCNL patients (29% vs 6%, p=0.04). When looking at patients who underwent angiography only, embolization rates were still higher among those on anticoagulation (29% vs 0%); however, this difference was not statistically significant (p=0.4).  

Conclusion

Severe bleeding complications requiring angiography are rare following PCNL mirroring estimates in the literature at 1.4%. Furthermore only 0.9% of all patients across this large health system required embolization, comprising 58% of all patients undergoing angiography. The only statistically significant difference in our study was the use of pre-operative anti-coagulation. Due to the rarity of this condition, further work is needed to better identify at-risk patients and expedite treatment when needed and reduce unnecessary contrast load in patients unlikely to benefit from intervention.

Funding

n/a

Co-Authors

Gregory Mullen,
The Smith Institute for Urology, Northwell Health

Jared Winoker,
The Smith Institute for Urology, Northwell Health

David Hoenig,
The Smith Institute for Urology, Northwell Health

Zeph Okeke,
The Smith Institute for Urology, Northwell Health

Arun Rai,
The Smith Institute for Urology, Northwell Health

Tareq Aro,
The Smith Institute for Urology, Northwell Health