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Renal Vein Injury During Percutaneous Nephrolithotomy Procedure

View Article: PubMed Central - PubMed

ABSTRACT

Background:: Percutaneous nephrostolithotomy is an important approach for removing kidney stones. Puncturing and dilatation are two mandatory steps in percutaneous nephrolithotomy (PCNL). Uncommonly, during dilatation, the dilators can cause direct injury to the main renal vein or to their tributaries.

Case presentation:: A 75-year-old female underwent PCNL for partial staghorn stone in the left kidney. During puncturing and dilatation, renal vein tributary was injured, and the nephroscope entered the renal vein and inferior vena cava, which was clearly recognized. Injection of contrast material through the nephroscope confirms the false pathway to the great veins (renal vein and inferior vena cava). Bleeding was controlled intraoperatively by applying Amplatz sheath over the abnormal tract, the procedure was continued and stones were removed. At the end of the procedure, a Foley catheter was used as a nephrostomy tube and its balloon was inflated inside the renal pelvis and pulled back with light pressure to the lower calix, which was the site of injury to the renal vein tributaries, then the nephrostomy tube was closed; by this we effectively controlled the bleeding. The patient remained hemodynamically stable; antegrade pyelography was done on the second postoperative day, there was distally patent ureter with no extravasation, neither contrast leak to renal vein, and was discharged home at third postoperative day. After 2 weeks, the nephrostomy tube was gradually removed in the operative room, without bleeding, on the next day, Double-J stent was removed.

Conclusion:: Direct injury and false tract to the renal vein tributaries during PCNL can result in massive hemorrhage, and can be treated conservatively in hemodynamically stable patients, using a nephrostomy catheter as a tamponade.

No MeSH data available.


Related in: MedlinePlus

CT cross section slides showing large UPJ stone, thinning of left renal cortex, and renal pelvis dilation. Red arrow shows part of colon located beside left kidney (retro renal colon).
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f2: CT cross section slides showing large UPJ stone, thinning of left renal cortex, and renal pelvis dilation. Red arrow shows part of colon located beside left kidney (retro renal colon).

Mentions: A 75-year-old woman underwent PCNL for partial staghorn stone in the left kidney, causing moderate hydronephrosis (Fig. 1). The procedure was performed by experienced faculty urologists under spinal anesthesia, using antibiotic prophylaxis. After retrograde catheterization with a 7F ureteral catheter in the lithotomy position, the patient was turned prone and percutaneous access was established under fluoroscopic guidance after contrast injection through the ureteral stent. Access to the collecting system was achieved by single puncture of posterior lower calix under C-arm X-ray guidance, the site of puncture was 1 cm below 12th rib and 3 cm medial to posterior axillary line to avoid colonic injury (CT scan shows partly retrorenal colon) (Fig. 2). After tract dilatation using coaxial serial Teflon-coated dilators, a 24F Amplatz sheath was placed and a slender nephroscope 17F (Karl Storz) was used for the procedure.


Renal Vein Injury During Percutaneous Nephrolithotomy Procedure
CT cross section slides showing large UPJ stone, thinning of left renal cortex, and renal pelvis dilation. Red arrow shows part of colon located beside left kidney (retro renal colon).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5035830&req=5

f2: CT cross section slides showing large UPJ stone, thinning of left renal cortex, and renal pelvis dilation. Red arrow shows part of colon located beside left kidney (retro renal colon).
Mentions: A 75-year-old woman underwent PCNL for partial staghorn stone in the left kidney, causing moderate hydronephrosis (Fig. 1). The procedure was performed by experienced faculty urologists under spinal anesthesia, using antibiotic prophylaxis. After retrograde catheterization with a 7F ureteral catheter in the lithotomy position, the patient was turned prone and percutaneous access was established under fluoroscopic guidance after contrast injection through the ureteral stent. Access to the collecting system was achieved by single puncture of posterior lower calix under C-arm X-ray guidance, the site of puncture was 1 cm below 12th rib and 3 cm medial to posterior axillary line to avoid colonic injury (CT scan shows partly retrorenal colon) (Fig. 2). After tract dilatation using coaxial serial Teflon-coated dilators, a 24F Amplatz sheath was placed and a slender nephroscope 17F (Karl Storz) was used for the procedure.

View Article: PubMed Central - PubMed

ABSTRACT

Background:: Percutaneous nephrostolithotomy is an important approach for removing kidney stones. Puncturing and dilatation are two mandatory steps in percutaneous nephrolithotomy (PCNL). Uncommonly, during dilatation, the dilators can cause direct injury to the main renal vein or to their tributaries.

Case presentation:: A 75-year-old female underwent PCNL for partial staghorn stone in the left kidney. During puncturing and dilatation, renal vein tributary was injured, and the nephroscope entered the renal vein and inferior vena cava, which was clearly recognized. Injection of contrast material through the nephroscope confirms the false pathway to the great veins (renal vein and inferior vena cava). Bleeding was controlled intraoperatively by applying Amplatz sheath over the abnormal tract, the procedure was continued and stones were removed. At the end of the procedure, a Foley catheter was used as a nephrostomy tube and its balloon was inflated inside the renal pelvis and pulled back with light pressure to the lower calix, which was the site of injury to the renal vein tributaries, then the nephrostomy tube was closed; by this we effectively controlled the bleeding. The patient remained hemodynamically stable; antegrade pyelography was done on the second postoperative day, there was distally patent ureter with no extravasation, neither contrast leak to renal vein, and was discharged home at third postoperative day. After 2 weeks, the nephrostomy tube was gradually removed in the operative room, without bleeding, on the next day, Double-J stent was removed.

Conclusion:: Direct injury and false tract to the renal vein tributaries during PCNL can result in massive hemorrhage, and can be treated conservatively in hemodynamically stable patients, using a nephrostomy catheter as a tamponade.

No MeSH data available.


Related in: MedlinePlus