Renal access through the inferior calyx is associated with higher risk of severe bleeding after percutaneous nephrolithotomy

Introduction: Hemorrhage is a major complication after percutaneous nephrolithotomy (PCNL). In the current study, we analyzed the risk factors for severe bleeding after PCNL. Material and methods: Medical records of 982 consecutive patients undergoing PCNL at the Department of Urology, the Third Xiangya Hospital, were reviewed. The type of stone included: solitary (n = 471), multiple (n = 192) and staghorn (n = 319). 139 patients had renal stones of solitary kidney or functional solitary kidney. The puncture site was the inferior calyx in 246 cases, the middle calyx in 651 cases, and the upper calyx in the remaining 85 cases. Results: The success rate (complete removal of the stone) was 92.8%, 73.4%, and 80.9% for solitary, multiple and staghorn stones, respectively. Severe bleeding occurred in 3.25% (8/246) of the cases with inferior calyx access, and 0.3% (2/651) in cases with middle calyx access. No severe bleeding occurred in patients with upper calyx access. The bleeding was controlled successfully with focal embolization under angiography in all 10 cases. Conclusions: Severe postoperative bleeding after PCNL is associated with renal puncture via the inferior calyx, multiple renal stones and solitary kidney stones.