238 Journal of the College of Physicians and Surgeons Pakistan 2018, Vol. 28 (3): 238-239 INTRODUCTION Since its introduction in 1976, 1 percutaneous nephro- litholtomy (PCNL) has become the gold standard treatment for renal stones requiring surgery. In addition to other complications, hemorrhage is its most common complication. 1 Hemorrhage may be venous or arterial. Venous bleed is usually treated conservatively while the arterial bleed requires special attention, as it may be due to postoperative renal artery pseudoanurysm, arterio-venous or arterio-calyceal fistula. Renal artery pseudoanurysm is a rare complication that occurs after renal trauma, renal biopsy, percutaneous nephrostomy, PCNL and partial nephrectomy, 2,3 and deserves meticulous care and treatment. Diagnosis and treatment of renal arterial pseudoaneurysm is made by renal angiography and arterial embolization, respectively. 4,5 CASE REPORT A 30-year female presented to us with complaint of right flank pain for 6 months. On examination, her abdomen was soft. Right flank was non-tender with no visceromegaly. Her laboratory investigations were within normal range. Ultrasonography showed right renal stone of 3 cm with mild hydronephrosis. The left kidney was normal. X-ray kidney ureter bladder (KUB) showed radiopaque right renal pelvic stone (Figure 1). She underwent right PCNL. The stone was approached from the lower pole. Complete fragmentation of the stone was done and nephrostomy was placed. The patient was discharged on the 3rd postoperative day after the removal of nephrostomy. At 13th day of discharge, patient presented with the high grade fever along with gross hematuria. Prophylactic intravenous antibiotics were commenced initially and later, according to the sensitivity report, blood was transfused. Her bladder wash was done and blood clots were evacuated. She was discharged on the 5th day. After 10 days, she presented with the complaint of urinary retention and history of gross hematuria for 3 days. Perurethra catheterization and bladder wash were done with evacuation of clots. Blood was also transfused. Her cystoscopy was done which revealed a large organised clot, which was evacuated too. At night, she again developed massive hematuria. Exploration of the right kidney was planned and done, once the patient's condition was optimized. Operative finding was a healthy kidney with clots in the renal pelvis, which were evacuated but no incidence of active bleeding. Wound was closed after placement of nephrostomy tube. The next day, she again developed gross hematuria alongwith bleeding in the nephrostomy tube. Her renal CT angiogram was carried out which showed a psuedoanurysm of interlobar branch of right renal artery. The following day, her renal angiography with subsequent selective angioembolization was done with the coil (Figures 2 and 3). She was kept under observation for 4 days and finally discharged. DISCUSSION Renal calculi are nowadays treated with minimal access surgery, like PCNL and retrograde intrarenal surgery (RIRS). The stone-free rate for calculi > 2 cm is found to be 71% and 37% for PCNL and RIRS, respectively. 1 There are various reports in literature related to a safety margin of PCNL, but some unique complications of the procedure still remain dreadful. 1 The rate of venous hemorrhage, which needs blood transfusion, is 7.3%; CASE REPORT Post-PCNL Renal Artery Pseudoanurysm Safdar Shah 1 , Abeer Fatima 2 , Muhammad Danial Ali Shah 3 , Wajid Ali 1 , Irfan Ahmed Gorya 1 and Fawad Nasrullah 4 ABSTRACT A renal artery pseudoaneurysm is a rare but important complication that can occur after renal trauma, renal biopsy, percutaneous nephrostomy, percutaneous nephrolithotomy (PCNL), and partial nephrectomy. The incidence of this potentially life-threatening complication is less than 1%, but is likely to increase with the increasing popularity of endoscopic renal procedures. We present a case of a 30-year female who underwent right PCNL for a right renal pelvic stone. Two weeks later, she presented with massive hematuria. Renal angiography revealed psuedoanurysm of interlobar artery which was successfully treated with coil embolization. Key Words: Hematuria. Pseudoaneurysm. Renal stone. 1 Department of Urology, KEMU/Mayo Hospital, Lahore. 2 Student, Allama Iqbal Medical College, Lahore. 3 Student, King Edward Medical University, Lahore. 4 Department of Urology, Postgraduate Medical Institute, Lahore. Correspondence: Prof. Safdar Shah, Head, Department of Urology, Hemodialysis and Renal Transplantation, KEMU/ Mayo Hospital, Lahore. E-mail: drsafdar-ali@hotmail.com Received: April 28, 2016; Accepted: October 30, 2017.