CU 65. Renal access through the inferior calyx is associated with higher risk of severe bleeding after percutaneous nephrolithotomy

Objective: Hemorrhage is a major complication after percutaneous nephrolithotomy (PCNL). In the current study, we analyzed the risk factors for severe bleeding after PCNL.

Material and Methods: Medical records of 982 consecutive patients receiving PCNL at the Department of Urology, the Third Xiangya Hospital, were reviewed. The type of the stone included: Solitary (n=471), multiple (n=192) and staghorn (n=319). The patients had only one kidney in 139 cases. The puncture site was inferior calyx in 246 cases, middle calyx in 651 cases, and upper calyx in the remaining 85 cases.

Results: The success rate (complete removal of the stone) was 92.8% ,73.4% and 80.9% for solitary, multiple and staghorn stones, respectively. Severe bleeding occured in 3.25% (8/246) of the cases with inferior calyx access, and 0.3% (2/651) in cases with middle calyx access. No severe bleeding occurred in patients with upper calyx access. The bleeding was controlled successfully with focal embolization under angiography in all 10 cases.

Conclusions: Severe postoperative bleeding after PCNL is associated with renal puncture via the inferior calyx, multiple renal stones and solitary kidney stones.