UROLOGY • June 2015 EMJ EUROPEAN MEDICAL JOURNAL 63 OUTCOMES OF SIX PATIENTS WHO WERE TREATED WITH SELECTIVE EMBOLISATION DUE TO ARTERIOVENOUS FISTULA FOLLOWING PERCUTANEOUS NEPHROLITHOTOMY Cemal Selcuk Isoglu, *Tufan Suelozgen, Mehmet Yoldas, Hakan Turk, Mustafa Karabicak, Batuhan Ergani, Yusuf Ozlem Ilbey Department of Urology, Tepecik Training and Research Hospital, Izmir, Turkey *Correspondence to tsuelozgen@hotmail.com Disclosure: The authors have declared no conflicts of interest. Accepted: 01.05.15 Citation: EMJ Urol. 2015;3[3]:63-66. ABSTRACT Objective: Arteriovenous fistula (AVF) is a rare yet serious complication of percutaneous nephrolithotomy (PCNL). The aim of this study was to investigate the preoperative characteristics and postoperative outcomes of patients treated with single-session selective embolisation following a diagnosis of AVF after PCNL. Methods: Data from 1,200 patients who underwent PCNL in our department between January 2008 and December 2014 were retrospectively reviewed. Overall, six patients who experienced delayed haematuria and were diagnosed with AVF formation were included. Patient characteristics, stone burden, PCNL procedure, and perioperative and postoperative parameters were evaluated. Results: Six patients with a mean age of 52 years (range: 42-57) were admitted to hospital with delayed intermittent haematuria following PCNL. All pre-PCNL stones in these patients were staghorn in type. Four patients (66%) had multiple access. Three patients needed blood transfusion due to development of hypotension. Following the diagnosis of AVF via angiography, all six patients were treated with selective embolisation during the same session. No additional treatment was required and no complications detected. Conclusion: AVF formation is one of the causes of delayed haemorrhage after PCNL. Multiple accesses, staghorn stones, and upper calyx entry increase the risk of bleeding and AVF formation. Patients with risk factors should be informed about delayed bleeding and possible complications of PCNL. Keywords: Kidney stone, nephrolithotomy, delayed haemorrhage, arteriovenous fistula. INTRODUCTION Percutaneous nephrolithotomy (PCNL) is generally considered a relatively safe technique, offering the highest success rates after the first treatment when compared with other minimally invasive lithotripsy techniques. 1 In 1981, the initial series of PCNL was reported by Wickham et al. 2 Increasing experience and developing technology have led to decreased complication rates. However, serious complications may occur following this procedure. Bleeding requiring transfusion is one of the most important complications, and arteriovenous fistulae (AVFs) are a rare cause of bleeding seen in 1-2% of all cases. 3,4 In this study we reviewed the data of six patients who were treated with selective embolisation due to AVF following PCNL. PATIENTS AND METHODS Data from 1,200 patients who underwent PCNL procedures between January 2008 and December 2014 were retrospectively reviewed. Overall, six patients who were diagnosed with AVF were included in our study. Preoperative patient evaluation included history, clinical examination, serum creatinine level, complete blood count, coagulation profile, and liver function tests.