174 Correspondence Murat Tuncer MD, Dr. Lütf Kırdar Kartal Training and Research Hospital, Clinic of Urology, İstanbul, Turkey Phone: +90 216 441 39 00/18 07 E-mail: drmurattuncer@hotmail.com Received: 28.10.2015 Accepted: 10.11.2015 Murat Tuncer 1 , Gökhan Faydacı 1 , Bilal Eryıldırım 1 , Emre Çamur 1 , Elif O. Tuncer 2 , Feyyaz Baltacıoğlu 3 , Aydın Özgül 1 , Kemal Sarıca 1 1 Dr. Lütf Kırdar Kartal Training and Research Hospital, Clinic of Urology, İstanbul, Turkey 2 Medeniyet University Faculty of Medicine, Department of Radiology, İstanbul, Turkey 3 Marmara University Faculty of Medicine, Department of Radiology, İstanbul, Turkey It is known that renal angiography and embolization is an effective and safe method in massive bleeding after percutaneous nephrolithotomy. In our study, we found that renal angiography is superior to renorraphy. What’s known on the subject? and What does the study add? ABSTRACT ÖZ Objective We present two treatment modalities, selective renal angioembolization and renorraphy, in massive renal hemorrage after percutaneous nephrolithotomy (PCNL) that could not be controlled by conservative methods. Materials and Methods One thousand two-hundred patients, who had undergone PCNL between January 2003 and February 2014, were retrospectively reviewed. From these cases, we selected patients with massive post procedural bleeding that could not be taken under control by conservative methods and we reviewed their clinical course and treatment results. Results Bleeding could not controlled by conservative methods in 6 patients and, angioembolization was done succesfully. In 3 patients, angioembolization was not available. Renorraphy was performed in 2 patients and nephrectomy in 1 patient at frst attempt. Renorraphy could not solve the problem of massive hemorrage and these 2 patients eventually underwent nephrectomy. Conclusion Renal angiography and embolization is an effective and safe method and renorraphy should not be the frst option in massive bleeding after PCNL that can not be taken under control by conservative methods. Keywords Percutaneous nephrolithotomy, bleeding, embolization, renorraphy Amaç Perkütan nefrolitotomi (PNL) sonrası konservatif yöntemlerle kontrol altına alınamayan masif kanamalarda uygulanan selektif angioembolizasyon ve renoraf tedavi yöntemlerini sunmayı amaçladık. Gereç ve Yöntem Ocak 2003 ile Şubat 2014 arasında PNL yapılan 1,200 hasta retrospektif olarak incelendi. Girişim sonrası masif kanaması olan ve konservatif yöntemlerle kontrol edilemeyen hastalar çalışmaya alındı ve klinik gidişatları ile tedavi sonuçları sunuldu. Bulgular Kanaması konservatif yöntemlerle durmayan 6 hastaya başarılı bir şekilde angioembolizasyon yapıldı. Angioembolizasyon 3 hastaya yapılamadı. İki hastaya renoraf ve 1 hastaya ise direkt nefrektomi yapıldı. Renoraf yapılan 2 hastada masif kanama devam etmesi üzerine bu hastalara nefrektomi yapılmak zorunda kalındı. Sonuç PNL sonrası konservatif yöntemlerle durdurulamayan masif kanamalarda renal angioembolizasyon etkili ve güvenli bir yöntemdir, renoraf ilk seçenek olmamalıdır. Anahtar Kelimeler Perkütan nefrolitotomi, kanama, embolizasyon, renoraf Perkütan Nefrolitotomi Sonrası Masif Kanamaların Tedavisi: Angioembolizasyon ve Renoraf Management of Massive Hemorrhage after Percutaneous Nephrolithotomy: Angioembolization or Renorrhaphy ORIGINAL RESEARCH ENDOUROLOGY Doi: 10.4274/jus.421 J Urol Surg 2015; 4: 174-178