Influence of technique of percutaneous tract creation on incidence of renal hemorrhage

Purpose: Renal hemorrhage is one of the most common and worrisome complications of percutaneous renal surgery. We studied the incidence of renal hemorrhage and transfusion rates in patients undergoing balloon or Amplatz fascial dilation of the nephrostomy tract. Materials and Methods: Medical records of 143 patients who underwent 150 percutaneous renal procedures, including percutaneous nephrolithotomy, antegrade endopyelotomy and percutaneous treatment of stones in caliceal diverticula, were reviewed. The nephrostomy tract was dilated with balloon (50 patients) or Amplatz sequential (100) dilators. Perioperative decreases in hemoglobin level and blood transfusion rates were compared between the 2 groups. Results: Of the 100 patients undergoing percutaneous renal Amplatz dilation 25 (25%) required a blood transfusion, compared to only 5 of 50 (10%) undergoing balloon dilation. The difference in the transfusion rates between the 2 groups was statistically significant (p = 0.048). Conclusions: Improvements in the technique of percutaneous renal surgery have decreased the morbidity associated with these procedures. In our study use of balloon tract dilators led to less renal hemorrhage and lower transfusion rates compared to Amplatz dilation. Additionally, balloon dilation appears to be more rapid and avoids renal movement away from the surgeon, which occasionally occurs during Amplatz dilation.