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      Embolisation d’un faux anévrisme artériel sur rein unique: à propos d’une complication rare de la néphrolithotomie percutanée Translated title: Embolization of a false arterial aneurysm in a patient living with one kidney: about a rare complication of percutaneous nephrolithotomy

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          Abstract

          La néphrolithotomie percutanée s’accompagne d’un risque de complications en particulier hémorragiques, qui en fait une technique potentiellement invasive. Nous rapportons le cas d’une patiente de 70 ans, traitée auparavant pour néphrolithotomie percutanée d’une lithiase sur un rein unique gauche. Une hématurie persistante de moyenne abondance est apparue il y a 2 mois et demi, et qui a motivé à la réalisation d’une tomodensitométrie découvrant un faux anévrisme intra rénal polaire inférieur, d’origine iatrogène. Il a nécessité une embolisation sélective efficace à la colle biologique.

          Translated abstract

          Percutaneous nephrolithotomy is a potentially invasive technique associated with a risk of complications, in particular bleeding. We report the case of a 70-year old female patient who had only left kidney and with a history of renal calculi treated with percutaneous nephrolithotomy. Persistent, average abundant haematuria had occurred two and a half months before, requiring computerized tomography (CT) scan. This had showed false iatrogenic intrarenal inferior polar aneurysm. It required effective selective embolization of biological glue.

          Most cited references15

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          Post-percutaneous nephrolithotomy extensive hemorrhage: a study of risk factors.

          We identified risk factors predicting severe bleeding due to percutaneous nephrolithotomy. Computerized data on 2,909 patients who underwent a total of 3,878 percutaneous nephrolithotomy procedures between January 1995 and December 2005 were retrospectively reviewed. Data on patients who experienced severe bleeding requiring angiographic renal embolization were compared with those on other patients using univariate and multivariate analyses. We tested the characteristics of patients, kidneys and stones together with details of the operative procedure and surgeon experience. Severe bleeding complicated a total of 39 procedures (1%) in 25 males and 14 females with a mean age of 50.7 +/- 12.6 years. Associated morbidity included shock in 6 patients and perirenal hematoma in 4. Renal angiography revealed pseudoaneurysm in 20 patients, arteriovenous fistula in 9, the 2 lesions in 8 and arterial laceration in 2. Bleeding could be controlled with superselective embolization in 36 patients (92.3%). Followup was available on 33 patients (mean 21 +/- 15 months). Renal function was stable in all patients except 3 who had a post-embolization increase in serum creatinine, of whom all had a solitary kidney and none required renal replacement therapy. Significant risk factors for severe bleeding were upper caliceal puncture, solitary kidney, staghorn stone, multiple punctures and inexperienced surgeon. Percutaneous nephrolithotomy should be performed by an experienced endourologist in patients at risk for severe bleeding, such as those with a solitary kidney or staghorn stones.
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            Percutaneous nephrolithotomy with ultrasonography-guided renal access: experience from over 300 cases.

            To report our experience with over 300 patients treated with percutaneous nephrolithotomy (PNL), for although PNL was established as a treatment in the 1970s, its use diminished with the introduction of extracorporeal shockwave lithotripsy (ESWL); clinical experience with ESWL showed its limitations, and the role of PNL for treating urolithiasis was redefined, which with improvements in instruments and lithotripsy technology has expanded the capability of percutaneous stone disintegration. The study included 315 patients (156 males, 159 females, aged 13-85 years) treated with PNL in our department between 1987 and 2002. The mean (range) stone diameter was 27 (7-52) mm. The kidney was punctured under ultrasonography guidance via a lower-pole calyx whenever possible. The working channel was dilated using an Alken dilator under X-ray control. If necessary, a flexible renoscope was used. Ultrasonic, pneumatic and laser probes were used for lithotripsy. Four weeks after treatment the total stone-free rate was 96.5%; 45.7% of all patients were primarily stone-free, 21.3% had clinically insignificant residual stones that passed spontaneously within 4 weeks after PNL, and 33% of the patients needed auxiliary measures (a second PNL, ESWL, ureterorenoscopy). Overall, the early complication rate was 50.8%, the most common complications being transient fever (27.6%), clinically insignificant bleeding (7.6%) or both (3.2%); 3.5% of the patients developed urinary tract infections (with no signs of urosepsis), 3.2% had renal colic and 2.9% upper urinary tract obstruction. One patient (0.3%) developed acute pancreatitis after PNL; one died from urosepsis and one needed selective angiographic embolization of the punctured kidney due to bleeding. No patient required transfusions and there were no injuries to neighbouring organs. These results show that PNL causes no significant blood loss or major complications in almost all patients. Two aspects may especially reduce the potential complications: ultrasonography-guided renal puncture and using PNL in an experienced centre. PNL is a highly efficient procedure that provides fast and safe stone removal.
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              Contemporary surgical trends in the management of upper tract calculi.

              Upper tract nephrolithiasis is a common surgical condition that is treated with multiple surgical techniques, including shock wave lithotripsy, ureteroscopy and percutaneous nephrolithotomy. We analyzed case logs submitted to the ABU by candidates for initial certification and recertification to help elucidate the trends in management of upper tract urinary calculi.
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                Author and article information

                Journal
                Pan Afr Med J
                Pan Afr Med J
                PAMJ
                The Pan African Medical Journal
                The African Field Epidemiology Network
                1937-8688
                28 February 2020
                2020
                : 35
                : 60
                Affiliations
                [1 ]Service de Radiologie du Centre Hospitalier Universitaire Hassan II Fès, Université Sidi Mohammed Ben Abdellah, Faculté de Médecine et de Pharmacie de Fès, Fès, Maroc
                [2 ]Service de Radiologie du Centre Hospitalier Universitaire Mohammed VI Oujda, Oujda, Maroc
                Author notes
                [& ]Auteur correspondant: Traore Abdoulaye Ababacar, Service de Radiologie du Centre Hospitalier Universitaire Hassan II Fès, Université Sidi Mohammed Ben Abdellah, Faculté de Médecine et de Pharmacie de Fès, Fès, Maroc
                Article
                PAMJ-35-60
                10.11604/pamj.2020.35.60.14626
                7250218
                64c717fb-cfab-48ba-9f78-a4e50c234806
                © Traore Abdoulaye Ababacar et al.

                The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 17 December 2017
                : 16 January 2019
                Categories
                Case Report

                Medicine
                percutaneous nephrolithotomy,one kidney,computed tomography,false aneurysm,embolization,néphrolithotomie percutanée,rein unique,tomodensitométrie,faux anévrisme,embolisation

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