Failure of Initial Renal Arterial Embolization for Severe Post-Percutaneous Nephrolithotomy Hemorrhage: A Multicenter Study of Risk Factors

No AccessJournal of UrologyAdult Urology1 Dec 2013Failure of Initial Renal Arterial Embolization for Severe Post-Percutaneous Nephrolithotomy Hemorrhage: A Multicenter Study of Risk Factors Guohua Zeng, Zhenhua Zhao, Shawpong Wan, Sanjay Khadgi, Yongfu Long, Yonghai Zhang, Guocan Cao, and Xiaoming Yang Guohua ZengGuohua Zeng Department of Urology, Minimally Invasive Surgery Center, First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangdong, People's Republic of China More articles by this author , Zhenhua ZhaoZhenhua Zhao Department of Urology, Minimally Invasive Surgery Center, First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangdong, People's Republic of China More articles by this author , Shawpong WanShawpong Wan Department of Urology, Minimally Invasive Surgery Center, First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangdong, People's Republic of China More articles by this author , Sanjay KhadgiSanjay Khadgi Venus International Hospital, Kathmandu, Nepal More articles by this author , Yongfu LongYongfu Long Department of Urology, Central Hospital of Shaoyang, Hunan, People's Republic of China More articles by this author , Yonghai ZhangYonghai Zhang Department of Urology, Shantou Central Hospital, Guangdong, People's Republic of China More articles by this author , Guocan CaoGuocan Cao Department of Urology, Hunan Chenzhou No. 4 People's Hospital, Hunan, People's Republic of China More articles by this author , and Xiaoming YangXiaoming Yang Department of Urology, Zhuzhou Kind Cardiovascular Disease Hospital, Hunan, People's Republic of China More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.06.085AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Severe hemorrhage after percutaneous nephrolithotomy is a rare but alarming event. If local tamponade fails to control bleeding, the current treatment of choice is superselective renal arterial embolization. If initial embolization is unsuccessful, repeat embolization or nephrectomy is often required. To our knowledge we report the first study of risk factors for failed initial superselective renal arterial embolization. Materials and Methods: We retrospectively reviewed the records of 17,619 patients who underwent a total of 19,185 percutaneous nephrolithotomies from January 2007 to April 2012 at 6 centers. Study inclusion criteria were percutaneous nephrolithotomy and severe postoperative renal hemorrhage requiring superselective renal arterial embolization. Data on patients in whom initial embolization failed were compared to those on patients with successful embolization on univariate and multivariate analysis. Results: Of the 17,619 patients 117 (0.6%), met study inclusion criteria, including 90 males and 27 females. Initial treatment failed in 12 patients (10.3%), 8 underwent repeat superselective renal arterial embolization, 3 required 3 embolizations and 1 underwent nephrectomy. Complete bleeding cessation was achieved in all 11 repeat embolization cases. We identified 3 risk factors for failure of initial superselective renal arterial embolization, including multiple percutaneous access sites, more than 2 bleeding sites identified on renal angiogram and gelatin sponge alone used as the embolic material. Conclusions: Carefully selecting patients for multitract percutaneous nephrolithotomy, making an extra effort to identify all bleeding vessels during angiography and not using gelatin sponge as the only embolic material could potentially decrease the risk of failure of initial superselective renal arterial embolization after percutaneous nephrolithotomy. References 1 : Post-percutaneous nephrolithotomy extensive hemorrhage: a study of risk factors. J Urol2007; 177: 576. Link, Google Scholar 2 : Embolization of iatrogenic vascular injuries of renal transplants: immediate and follow-up results. Cardiovasc Intervent Radiol1998; 21: 129. Google Scholar 3 : EAU guidelines on urological trauma. Eur Urol2005; 47: 1. Google Scholar 4 : Treatment of upper urinary calculi with Chinese minimally invasive percutaneous nephrolithotomy: a single-center experience with 12,482 consecutive patients over 20 years. Urolithiasis2013; 41: 225. Google Scholar 5 : Complications in percutaneous nephrolithotomy. Eur Urol2007; 51: 899. Google Scholar 6 : Selective transarterial embolization for posttraumatic renal hemorrhage: a second try is worthwhile. J Urol2011; 185: 1751. Link, Google Scholar 7 : Factors affecting blood loss during percutaneous nephrolithotomy: prospective study. J Endourol2004; 18: 715. Google Scholar 8 : Post-percutaneous nephrolithotomy septic shock and severe hemorrhage: a study of risk factors. Urol Int2012; 88: 307. Google Scholar 9 : A single percutaneous access and flexible nephroscopy is the best treatment for a full staghorn calculus. J Endourol2008; 22: 1835. Google Scholar 10 : Single upper-pole percutaneous access for treatment of > or = 5-cm complex branched staghorn calculi: is shockwave lithotripsy necessary?. J Endourol2002; 16: 477. Google Scholar 11 : Complications associated with percutaneous nephrostomies. A retrospective study. Acta Radiol2004; 45: 184. Google Scholar 12 : Factors affecting bleeding during percutaneous nephrolithotomy: single surgeon experience. J Endourol2011; 25: 327. Google Scholar 13 : Renal artery embolization: clinical indications and experience from over 100 cases. BJU Int2007; 99: 881. Google Scholar 14 : Transarterial glue embolization in iatrogenic renovascular injuries. Int Urol Nephrol2008; 40: 875. Google Scholar 15 : Percutaneous embolization of iatrogenic arterial kidney injuries: safety, efficacy, and impact on blood pressure and renal function. J Vasc Interv Radiol2011; 22: 1563. Google Scholar 16 : Embolization materials made of gelatin: comparison between Gelpart and gelatin microspheres. Cardiovasc Intervent Radiol2010; 33: 120. Google Scholar 17 : Stab wounds of the renal artery branches: angiographic diagnosis and treatment by embolization. AJR Am J Roentgenol1989; 152: 1231. Google Scholar 18 : Angiographic findings and embolotherapy in renal arterial trauma. Cardiovasc Intervent Radiol2005; 28: 39. Google Scholar 19 : Control of post renal biopsy hemorrhage by Gelfoam embolization. Nephron1981; 28: 149. Google Scholar 20 : Renal artery embolization using a new liquid embolic material obtained by partial hydrolysis of polyvinyl acetate (Embol): initial experience in six patients. Korean J Radiol2000; 1: 121. Google Scholar 21 : Renal artery embolization combined with radiofrequency ablation in a porcine kidney model: effect of small and narrowly calibrated microparticles as embolization material on coagulation diameter, volume, and shape. Cardiovasc Intervent Radiol2011; 34: 156. Google Scholar 22 : Long-term functional and morphological effects of transcatheter arterial embolization of traumatic renal vascular injury. BJU Int2008; 101: 473. Google Scholar © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 190Issue 6December 2013Page: 2133-2138Supplementary Materials Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Keywordsnephrostomyembolizationkidneypercutaneoustherapeutichemorrhagetreatment failureMetricsAuthor Information Guohua Zeng Department of Urology, Minimally Invasive Surgery Center, First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangdong, People's Republic of China More articles by this author Zhenhua Zhao Department of Urology, Minimally Invasive Surgery Center, First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangdong, People's Republic of China More articles by this author Shawpong Wan Department of Urology, Minimally Invasive Surgery Center, First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangdong, People's Republic of China More articles by this author Sanjay Khadgi Venus International Hospital, Kathmandu, Nepal More articles by this author Yongfu Long Department of Urology, Central Hospital of Shaoyang, Hunan, People's Republic of China More articles by this author Yonghai Zhang Department of Urology, Shantou Central Hospital, Guangdong, People's Republic of China More articles by this author Guocan Cao Department of Urology, Hunan Chenzhou No. 4 People's Hospital, Hunan, People's Republic of China More articles by this author Xiaoming Yang Department of Urology, Zhuzhou Kind Cardiovascular Disease Hospital, Hunan, People's Republic of China More articles by this author Expand All Advertisement PDF downloadLoading ...