Management of renal vein injury during percutaneous nephrostolithotomy:an experience with 2 cases

Objective To discuss the reasons and management of renal vein injury during percutaneous nephrostolithotomy(PCNL).Methods From 2007 to 2008 renal vein injury was caused in two patients by malposition of nephrostomic catheter in our hospital.The two patients were both males,aged 61 years old and 41 years old.They underwent PCNL due to left kidney stones.The percutaneous nephrostomy(PCN) catheters were malpositioned into the left kidney vein and vena cava,which was confirmed by prograde radiography and spiral CT scan after operation.The PCN catheter in the 41 years old patient was pulled back to renal collecting system on the 7th day,and was extracted on the 10th day under X-ray monitoring.The PCN catheter in the 61 years old patient was pulled back to the renal collecting system on the 14th day and was extracted on the 18th day under X-ray monitoring.Results The bleeding was controlled and the hemodynamic status was stable in the two cases after removal of PCN catheters.There was no renal arteriovenous fistula bleeding,surgical intervention,kidney infections or further damage of kidney function.Conclusion Renal vein injury during the PCNL can be managed by clamping the PCN catheter and gradual withdrawal.The method is safe and reliable,and it can avoid surgical intervention.