Current insights on haemorrhagic complications in percutaneous nephrolithotomy

OBJECTIVE: Percutaneous nephrolithotomy (PCNL) is the standard procedure for the management of large and complex renal stones. Blood loss during PCNL may occur during puncture, tract dilatation, and stone fragmentation. Therefore, despite recent advances in PCNL, haemorrhagic complication still occurs. This study aims to enlighten on various aspects of haemorrhagic complication in PCNL, mainly focusing on risk factors and management of this dreadful complication. METHODS: Literature search for the study was carried out using advanced search engines like PubMed, Cochrane, and Google Scholar, combining keyword “percutaneous lithotomy” with other keywords like “bleeding”, “haemorrhage”, “complications”, “stone scoring systems”, “mini-PCNL vs. standard”, “dilatation techniques”, “supine vs. prone”, “USG-guided”, “endoscopic combined intra-renal surgery”, “papillary vs. non-papillary puncture”, “bilateral”, and “angioembolization”. The articles published between January 1995 and September 2020 were included for the review. RESULTS: A total of 3670 articles published from January 1995 to September 2020 were screened for the review. Although not consistent, multiple studies have described various preoperative and intraoperative risk factors related to significant bleeding in PCNL. Identification of these risk factors help urologists to anticipate and promptly manage haemorrhagic complications associated with the procedure. A conservative approach suffices to control bleeding in most cases; nevertheless, bleeding can be life-threatening and few still need surgical intervention in the form of angiographic embolisation or open surgical exploration. CONCLUSION: As hemorrhagic complication in PCNL is associated with considerable morbidity and mortality, prudent intraoperative decision and postoperative care are necessary for its timely prevention, detection, and management.