ObjectiveTo analyze the causes and characteristics of massive hemorrhage secondary to percutaneous nephrolithotomy (PCNL) and assess the value of superselective renal artery embolization in the management of this condition. MethodsThe imaging data and prognosis of 28 patients who developed repeated massive hemorrhage secondary to PCNL and underwent superselective renal artery embolization between April 2005 and June 2013 were reviewed. ResultsFollowing superselective renal artery embolization, hemorrhage was effectively controlled in all the 28 patients. Follow-up lasted from 6 to 62 months, averaging 41.6 months. No hematuria or other complications occurred during the follow-up period. ConclusionSuperselective renal artery embolization is safe and effective in managing massive hemorrhage secondary to PCNL, and it may be used as a preferred treatment for patients who are refractory to expectant treatments.
The surgical case report（SCARE）statement is the report checklist made by European researchers in 2016, which is specialized for surgical case report. As a reference for enhancing the research quality and transparency, the SCARE statement provides a fundamental framework for surgical case reports. The last SCARE statement was revised in 2020, and this paper interprets it to provide a practical tool for domestic researchers in surgical case report.
ObjectiveTo evaluate the safety and efficacy of flexible ureteroscopic lithotripsy for patients with renal calculi of more than 2 cm in diameter. MethodsThe Clinical data of 37 patients with renal calculi of more than 2 cm in diameter treated with holmium laser lithotripsy through flexible ureteroscope between December 2012 and March 2015 were retrospectively analyzed. In this group, stone diameter was between 2.0 cm and 3.5 cm, including 22 cases of single stone and 15 cases of multiple stones. Preoperative ureteral stents were indwelt in all the patients for 1-2 weeks. After dilation of the ureter with F8/9.8 rigid ureteroscope, the ureteral access sheath for flexible ureteroscope was inserted to the target ureter followed by flexible ureteroscope. Stones were fragmentized by holmium laser and the power was not more than 30 W (1.0-1.5 J/15-20 Hz). ResultsThe success rate of ureteroscopic insertion was 100% (37/37). The operation time ranged from 40 to 185 minutes with a mean of 73 minutes. After the operation, one patient had sepsis, and was cured after positive anti-infection treatment. No other serious complications occurred. Four and 8 weeks after surgery, the free-stone rate was 73.0% (27/37) and 86.5% (32/37) respectively. ConclusionThe flexible ureteroscopic lithotripsy is advantageous in less trauma, fewer complications, quick recovery and higher free-stone rate. It can be used to treat renal calculi of over 2 cm in diameter selectively.