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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.


The figure shows contrast material left renal vein and both its tributaries. (A) Site of penetration of renal vein tributery during PCNL, (B) left main renal vein, (C) ureteral stent inside left ureter.
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f3: The figure shows contrast material left renal vein and both its tributaries. (A) Site of penetration of renal vein tributery during PCNL, (B) left main renal vein, (C) ureteral stent inside left ureter.

Mentions: During inspection by nephroscope of the lower calix, there was intense venous bleeding from the injured part of the lower calix and we followed the tract through luminal structure and we suspected the possibility of injury to the structures surrounding the left kidney. Through the nephroscope, contrast material was injected to the abnormal tract, and the left renal vein with two tributaries and inferior vena cava were seen (Fig. 3), consequently direct injury and penetration to the left renal vein was confirmed.


Renal Vein Injury During Percutaneous Nephrolithotomy Procedure
The figure shows contrast material left renal vein and both its tributaries. (A) Site of penetration of renal vein tributery during PCNL, (B) left main renal vein, (C) ureteral stent inside left ureter.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f3: The figure shows contrast material left renal vein and both its tributaries. (A) Site of penetration of renal vein tributery during PCNL, (B) left main renal vein, (C) ureteral stent inside left ureter.
Mentions: During inspection by nephroscope of the lower calix, there was intense venous bleeding from the injured part of the lower calix and we followed the tract through luminal structure and we suspected the possibility of injury to the structures surrounding the left kidney. Through the nephroscope, contrast material was injected to the abnormal tract, and the left renal vein with two tributaries and inferior vena cava were seen (Fig. 3), consequently direct injury and penetration to the left renal vein was confirmed.

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.