A clean single puncture and a stone 'pick up'. What would be a probable cause and line of treatment?
If I understand the question .... you have a patient with hematuria 10 after PCNL .....
We have not to much details (coagulation, platelets blood count, drugs, managemnt postPCNL, nephrostomy, stnt, etc). Nevertheless I think you should consider at least two things: 1) output of blood clot already filling the renal pelvis; 2) arterovenous fistula (that could probably require embolization).
If you give us more clinical details and some pictures probably we can help you better!
All investigations were within normal limits. Gross obesity was the only co-morbidity. Post-PCNL nephrostomy was kept for 2 days. Immediate post-op and first 10 days were completely uneventful.
I am agree with comments of Dr Luca Cindolo . Also after PCNL in some patients we have delayed hematuria due to clot lysis or microanurisms or arterovenous fistula . in many patients if hemodynamic state will be stable, with close observation and complete bed rest hematuria improved spontaneously. but it is beter that we perform an angiography ,and if we detect any vascular injury or complication treat it by sclerotherapy or angioembolization.
That's exactly what happened. Hematuria was significant enough to cause clot retention. Patient was stable through out the episode. Angiography was performed and showed no abnormality or cause for bleeding.
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