Percutaneous nephrolithotomy is a minimally invasive method of removing large or complex renal stones. Hemorrhage can occur following the procedure and can be life-threatening.
Patient selection: status post percutaneous nephrolithotomy
Risk factors for hemorrhage:
(1) coagulopathy
(2) inexperienced urologist
(3) multiple passes/punctures with the needle (difficulties trying to access the renal pelvis)
(4) difficult stone removal (staghorn, other)
(5) solitary kidney
(6) upper caliceal puncture
(7) vascular complication (damage to renal artery, arteriovenous fistula, pseudoaneurysm)
Most cases can be managed with selective embolization with or without blood transfusion. Other approaches can be used (electrocautery, proclotting agents).
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