Computed Tomography Angiography and Three-Dimensional Reconstruction of Renal Arteries in Diagnosing the Bleedings After Mini-Percutaneous Nephrolithotomy: A Single-center Experience of 7 Years



      This study aimed to investigate the role of computed tomography angiography (CTA) and three-dimensional (3D) reconstruction of renal arteries in the evaluation of bleeding after mini- percutaneous nephrolithotomy (PCNL).


      Thirty-one consecutive patients with continuous renal hemorrhage after mini-PCNL were enrolled from January 2015 to January 2022. Demographic and clinical data were retrospectively recorded and analyzed. All patients had received CTA evaluation and subsequently digital subtraction angiography (DSA) embolization to manage renal bleeding. CTA and 3D reconstruction of renal arteries were performed using the 320 multi-detector computed tomography technique and the images were evaluated by experienced radiologists. DSA embolization were performed by an interventional radiologist with more than 10 years of experiences.


      CTA and 3D construction of renal arteries showed 28 cases of vascular lesions (28/31, 90.3%), including 15 cases of pseudoaneurysm (15/28, 53.6%), 9 cases of arteriovenous fistula (9/28, 32.1%), and 4 cases of suspicious bleeding spot (4/28, 14.3%). While DSA revealed 31 cases of vascular lesions (100%), including 15 cases of pseudoaneurysm (15/31, 48.4%), 10 cases of arteriovenous fistula (10/31, 32.3%), 6 cases of bleeding spot and (6/31, 19.4%). The serum creatinine level was elevated slightly before mini-PCNL and after DSA embolization (73.1±18.1 vs 92.1±33.6, P <.01). 15 patients (15/31, 48.4%) required blood transfusion, with mean blood transfusion volume of 700 ml ±660 ml (range, 400 ml-1800 ml). The bleeding was controlled without any further severe complications.


      CTA and 3D reconstruction of renal arteries were safe and effective in diagnosing renal arterial bleedings after mini-PCNL, with a sensitivity of 90.3% and a specificity of 100%.


      CTA (computed tomography angiography), 3D (three dimensional), DSA (digital subtraction angiography), PCNL (percutaneous nephrolithotomy), Mini-PCNL (mini-percutaneous nephrolithotomy)
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        • Assimos D
        • Krambeck A
        • Miller NL
        • et al.
        Surgical management of stones: american urological association/endourological society guideline, PART I.
        J Urol. 2016; 196: 1153-1160
        • Wang FQ
        • Liu WZ
        • Yuan HS
        • et al.
        Acute pulmonary embolism and severe post thrombolysis renal bleeding, two deadly complications following mini-percutaneous nephrolithotomy: a rare case report.
        BMC Surg. 2022 Mar 23; 22: 108
        • Choi MJ
        • Kim PH
        • Shin JH
        • et al.
        Angiographic management of percutaneous renal procedure-related bleeding: a single-center experience.
        Int J Urol. 2019; 26: 406-412
        • Zhao Y
        • Shen B
        • Zhong B
        • et al.
        Renal artery computed tomography angiography for the application of severe bleeding after PCNL.
        Zhonghua Yi Xue Za Zhi. 2014; 94: 2687-2689
        • Ganpule AP
        • Shah DH
        • Ganpule SA
        • et al.
        Role of multi-detector computed tomography (MDCT) in management of post percutaneous nephrolithotomy (PCNL) bleeding.
        F1000 Res. 2013; 2: 253
        • Ruhayel Y
        • Tepeler A
        • Dabestani S
        • et al.
        Tract sizes in miniaturized percutaneous nephrolithotomy: a systematic review from the European Association of Urology Urolithiasis Guidelines Panel.
        Eur Urol. 2017; 72: 220-235
        • Turna B
        • Nazli O
        • Demiryoguran S
        • et al.
        Percutaneous nephrolithotomy: variables that influence hemorrhage.
        Urology. 2007; 69: 603-607
        • El-Nahas AR
        • Shokeir AA
        • El-Assmy AM
        • et al.
        Post-percutaneous nephrolithotomy extensive hemorrhage: a study of risk factors.
        J Urol. 2007; 177: 576-579
        • Said SH
        • Al Kadum Hassan MA
        • Ali RH
        • et al.
        Percutaneous nephrolithotomy; alarming variables for postoperative bleeding.
        Arab J Urol. 2017; 15: 24-29
        • Lee JK
        • Kim BS
        • Park YK.
        Predictive factors for bleeding during percutaneous nephrolithotomy.
        Korean J Urol. 2013; 54: 448-453
        • Amri M
        • Naouar S
        • Ben Khalifa B
        • et al.
        Predictive factors of bleeding and fever after percutaneous nephrolithotomy.
        Tunis Med. 2019; 97: 667-674
        • Meng X
        • Bao J
        • Mi Q
        • et al.
        The analysis of risk factors for hemorrhage associated with minimally invasive percutaneous nephrolithotomy.
        Biomed Res Int. 2019; 20198619460
        • Dong X
        • Ren Y
        • Han P
        • et al.
        Superselective renal artery embolization management of post-percutaneous nephrolithotomy hemorrhage and its methods.
        Front Surg. 2020 Nov 26; 7582261
        • Kim G
        • Soto JA
        • Morrison T.
        Radiologic assessment of gastrointestinal bleeding.
        Gastroenterol Clin North Am. 2018; 47: 501-514
        • He B
        • Yang J
        • Xiao J
        • et al.
        Diagnosis of lower gastrointestinal bleeding by multi-slice CT angiography: a meta-analysis.
        Eur J Radiol. 2017; 93: 40-45
        • Sivanandam SE
        • Mathew G
        • Bhat SH.
        Emerging role of multi-detector computed tomography in the diagnosis of hematuria following percutaneous nephrolithotomy: a case scenario.
        Indian J Urol. 2009; 25: 392-394