Introducing the POPVESL Score for Intrarenal Vascular Complications of Percutaneous Nephrolithotomy: Experience from a Single high-volume Referral Center
Vol. 18 No. 03 (2021),
Purpose: Percutaneous-nephrolithotomy (PCNL), is the current modality of choice for large renal stones. Delayed post-op bleeding may herald pseudo aneurysm (PA) or arteriovenous fistula (AVF) necessitating costly and inconsistently available angioembolization, or prolonged hospitalization. The goal of this study is to identify criteria that may predict response to conservative therapy, for delayed bleeding from post PCNL intrarenal vascular lesions.
Materials and methods: We reviewed all data on patients re-admitted for post PCNL gross hematuria at our high volume center between 2011 and 2016. Perioperative findings, factors related to the stone and management details, were subjected to multifactorial analysis. Logistic regression for multivariable analysis and ROC curves to find thresholds predicting mandatory angioembolization.
Results: Of 4403 PCNLs, 83 (1.9%) with delayed bleeding were diagnosed with intrarenal vascular lesions: Arteriovenous fistulas in 54 (AVF, 65%) and pseudoaneurysm in 29 (PA, 35%). Overall 49 (59%) responded to
conservative management but 34 (41%) eventually required angioembolization. On multivariable analysis, predictive factors for poor response to conservative treatment were requiring transfusion beyond initial stabilization, pseudoaneurysm, history of open renal surgery, longer interval-to-second-admission, and size of vascular lesion. The proposed POPVESL score (short for Post PNL Vascular Embolization selection) when below 11, correctly predicts success of conservative management with 81.6% sensitivity & 100% specificity.
Conclusion: Our findings including the proposed POPVESL score have the potential for clinical application and
enhancing practical guidelines on the management of post-PCNL bleeding.
- arteriovenous fistula
- conservative management
- percutaneous nephrolithotomy
- postoperative complications
- pseudo aneurysm
How to Cite
European association of urology. (2020). Guideline of Urolithiasis. Retrieved from https://uroweb.org/guideline/urolithiasis/ accessed 1/17/2020
Michel MS, Trojan L, Rassweiler JJ. Complications in percutaneous nephrolithotomy. European Urology. 2007; 51(4):899-906
Matlaga BR, Krambeck AE, Lingeman JE: Surgical management of upper urinary tract calculi. In: Wein AJ, Kavoussi LR, Partin AW et al. Campbell-Walsh Urology-Eleventh edition. Philadelphia: Elsevier, 2016, pp 1111-282.
Zabkowski T, Piasecki P, Zielinski H, et al. Superselective renal artery embolization in the treatment of iatrogenic bleeding into the urinary tract. Medical Science Monitor. 2015; 21:333-37.
Demey A, Colomb F, Pebeyre B, et al. Persistent hematuria after embolization for hemorrhagic complication following percutaneous nephrolithotomy: value of the study of red blood cell volume in urine. Progres en urologie. 2003; 13(3):486-90.
Li L, Zhang Y, Chen Y, et al. A multicentre retrospective study of transcatheter angiographic embolization in the treatment of delayed haemorrhage after percutaneous nephrolithotomy. European Radiology. 2015; 25(4):1140-47.
El Tayeb MM, Knoedler JJ, Krambeck AE, et al. Vascular complications after percutaneous nephrolithotomy: 10 years of experience. Urology. 2015; 85(4):777-81.
Un S, Cakir V, Kara C, et al. Risk factors for hemorrhage requiring embolization after percutaneous nephrolithotomy. Canadian Urological Association Journal = Journal de l'Association des Urologues du Canada. 2015; 9(9-10):E594-98.
Etemadian M, Soleimani MJ, Haghighi R, et al. Does bleeding during percutaneous nephrolithotomy necessitate keeping the nephrostomy tube? A randomized controlled clinical trial. Urology Journal. 2011; 8(1):21-6.
Stoller ML, Wolf JS Jr, St Lezin MA. Estimated blood loss and transfusion rates associated with percutaneous nephrolithotomy. The Journal of Urology. 1994; 152(6 Pt 1):1977-81.
Srivastava A, Singh KJ, Suri A, et al. Vascular complications after percutaneous nephrolithotomy: Are there any predictive factors? Urology. 2005; 66(1):38-40.
Seetharama Madhusudhan K, Ananthashayana Venkatesh H, Gamanagatti Sh, Interventional Radiology in the Management of Visceral Artery Pseudoaneurysms: A Review of Techniques and Embolic Materials, Korean J Radiol. 2016 May-Jun; 17(3): 351–63.
Ierardi AM, Floridi C, Fontana F, et al. Transcatheter embolisation of iatrogenic renal vascular injuries. Radiol Med 2014;119:261-8.
Jain S, Nyirenda T, Yates J, et al. Incidence of renal artery pseudoaneurysm following open and minimally invasive partial nephrectomy: a systematic review and comparative analysis. J Urol 2013;189:1643-8.
Shapiro EY, Hakimi AA, Hyams ES, et al. Renal artery pseudoaneurysm following laparoscopic partial nephrectomy. Urology 2009;74:819-23.
Fergus KB, Baradaran N, Tresh A, Use of angioembolization in urology: a review, Transl Androl Urol 2018;7(4):535-44
- Abstract Viewed: 0 times
- 5997/pdf Downloaded: 0 times