Emergent Intervention Criterias for Controlling Sever Bleeding after Percutaneous Nephrolithotomy

Objectives. To determine when emergent intervention for bleeding after percutaneous nephrolithotomy (PCNL) is required. Methods. We reviewed analysis data of 850 patients who had undergone PCNL in our center. Blood transfusion was needed for 60 (7%) patients during and/or after surgery. We routinely performed followup of the urine output per hour, blood pressure, and hemoglobin levels after PCNL. Five (0.6%) of them had severe bleeding that emergent intervention was needed. Results. The mean age of the 5 patients who had emergent surgery due to severe bleeding was 42.2 (19–56) years. Mean duration of surgery was 44.75 (25–65)？minutes. Mean stone size was 27 (15–38)？mm. Mean decrease of hemoglobin was 4.8 (3.4–5.8)？ng/dL, and unit of transfused blood was 4.4 (3–6). Mean blood pH was 7.21. There were metabolic acidosis and anuria/oliguria in all these patients. One of 5 patients suffered from cardiopulmonary arrest because of massive bleeding four hours after the PCNL, and despite cardiac resuscitation, he died. Hemorrhaging was controlled by open surgery in the other 4？patients. Two patients experienced cardiac arrest during the open surgery but they responded to cardiac resuscitation. There were no metabolic asidosis and anuria/oliguria, and bleeding was managed only with blood transfusion for the other 55？patients. Conclusion. Severe bleeding after PCNL is rare and can be mortal. If metabolic asidosis and anuria/oliguria accompanied the drop of hemoglobin, emergent surgical intervention should be performed because vascular collapse may follow, and it may be too difficult to stabilise the patient. 1. Introduction Urolithiasis is a common disease, and the prevalence of this disease is increasing everyday [1]. Percutaneous nephrolithotomy (PCNL) is an effective and common treatment technique for especially large and complex renal calculi. Although PCNL is a common procedure, it can be associated with some mortal or morbid complications such as septicemia, severe bleeding, and pleural or colonic injury. With this study, we documented patients who needed blood transfusion and patients who had renal hemorrhaging requiring emergent intervention after PCNL. We aimed to answer questions including “how long conservative therapy for bleeding after PCNL takes?” and “when emergent intervention should be performed?” To our knowledge, this is the first paper to investigate this topic regarding PCNL. 2. Material and Methods 2.1. Patients We performed a retrospective analysis of 850 patients who underwent PCNL in the urology department of our institute. Before the