Urology Video Journal (Dec 2020)
Late migration of huge coil after angioembolization for post-PCNL bleeding
Abstract
Background: Percutaneous nephrolithotomy (PCNL) is a minimally invasive technique for treating renal stone disease and well-established postoperative complications in the literature. Bleeding is one of the most common and significant complication of PCNL [1]. Treatment of this complication is commonly conservative including blood transfusion, which is enough for the relief of symptoms. But in a small number of patients, transcatheter angioembolization (TCA) is needed for persistent bleeding [2]. Coil migration is a rare complication of TCA [3]. Objectives: In this study, we present a migrated coil into the collecting system after angioembolization for bleeding-related PCNL. Case presentation: A 52 years old patient with left solitary kidney underwent PCNL. The operation was finished uneventfully, but bleeding occurs after the procedure and treated with TCA. The patient was discharged after the relief of symptoms. After two years, the patient had started complaining left flank pain. A huge metal coil wire was founded in X-ray KUB. The coil wire was filling the renal pelvis and prolapsing to the proximal ureter. A Double J stent was inserted to the patient for preparing to flexible ureteroscopy. Ureterorenoscopy was performed, and extraluminal coil wires were cut off using a holmium laser (1.2 J &10 Hz; 12 watt) and extracted with forceps. The operation was performed using semirigid ureteroscope. No ureteral access sheath was used due to adequate ureteral diameter allowing safe retrieval of the coil while minimizing operative time, complications, and eliminating the need for stenting. Ureteral stent was not inserted. The postoperative period was uneventful, and the patient discharged in the postoperative 1st day. The patient was under follow up without any problem for two years and did not underwent a second procedure for the tips of coils. Conclusion: Coil migration is a late and rare complication of embolization. Management of coil migration is commonly surgical. The antegrade and retrograde approaches are minimally invasive methods with a high success rate. The retrograde approach provides urologists with a safe and effective way to remove migrated coils due to the lower risk of bleeding and hospitalization time than the percutaneous approach.
