The application of superselective embolization of renal vessels in case of bleeding after percutaneous nephrolithotomy

Background. Bleeding, injures to surrounding organs and pleura are serious complications of percutaneous nephrolithotripsy. The inefficiency of hemostatic therapy is an indication for superselective embolization of the renal vessels. This technique demonstrates the high efficiency in case of postoperative bleeding. Aim. To develop a treatment algorithm and to evaluate an efficiency of superselective embolization of the renal vessels, based on the results of treatment ofpostoperative complications, which are associated with bleeding. Materials and methods. A retrospective analysis of 1375 patients treated from January 2011 to December 2018 for large (over 1.5 cm) and staghorn renal stones was performed. A number of patients had various complications in the early postoperative period, which were graded according to the Clavien-Dindo classification, including bleeding due to intraoperative damage to renal vessels, which required additional interventions. The treatment strategy was based on the assessment of volume and severity of blood loss as well as the hemodynamic stability. Results. Based on the severity of bleeding and hemodynamic stability, the treatment algorithm was developed. The analysis of the results of superselective embolization of renal arteries demonstrates the high effectiveness of this technique in case of postoperative bleeding. Conclusion. Superselective embolization is an effective method of hemostasis in case of postoperative bleeding. The proposed algorithm allows for early coordination of therapeutic measures depending on the severity ofbleeding and the patient’s condition in order to evaluate the risk of continued bleeding and the determine the optimal treatment strategy.

urolithiasis, bleeding, percutaneous nephrolithotripsy, superselective embolization