Treatment of delayed bleeding after percutaneous lithotripsy

This study presents our experience of late hemorrhagic complications and their treatment. From 1984 to 1997 827 percutaneous operations for renocalyceal calculosis (790) and lumbar ureter calculosis (37) were performed. The percutaneous access included the following steps: a retrograde ureteral catheterism, a puncture of the kidney in the posterolateral region, dilation with coaxial Alken dilatators up to 24 Fr, introduction of the nephroscope. Calculi were originally removed with an ultrasound lithotriptor and later with ballistic energy. At the end of the procedure we inserted a 24 Fr. Couvelaire nephrostomic catheter, removed after 72 h. Late bleeding occurred in 3 patients (0.4%) after a mean period of 14 days (range 10-20). With an angiographic catheter, a lesion of the inferior polar artery was observed in one case, and of an interlobar artery in the other two cases. Embolization of the injured vessel with tungsten coils resolved the bleeding quickly in all cases, with a 100% success rate. The incidence of serious vascular lesions due to percutaneous renal lithotripsy is low. Generally the extraparenchymal arterial vessels are affected. Bleeding in these cases cannot be resolved with the nephrostomic catheter because of lack of strong tissue for extravasal support. Treatment of choice for vascular lesions is embolization with a radiological technique which not only resolves bleeding but is also a kidney-sparing technique.