Rare Case of Delayed Bleeding Occurring 8 Years After Percutaneous Nephrolithotomy and Angioembolization: A Case Report and Current Literature Review

Over recent decades, percutaneous nephrolithotomy (PCNL) has risen as a primary treatment method, firmly establishing itself as the cornerstone approach for handling large kidney stones. Postoperative bleeding commonly stems from arteriovenous fistula (AVF), which is a connection formed between a damaged artery with high flow and a damaged vein with low flow, and pseudoaneurysm (PA), which involves arterial blood leaking into the tissue, causing a localized hematoma. The preferred technique for addressing such vascular complications is selective trans-arterial angioembolization, widely regarded as the gold standard. In this article, we present the case of a 42-year-old woman who experienced delayed bleeding eight years after PCNL and a previous angi-oembolization. The patient presented macroscopic hematuria, and further investigations, such as cystoscopy, contrast-enhanced abdomino-pelvic CT, and angiography, were performed. To stop the bleeding, we identified and performed selective angioembolization (SAE) with the embolization of a small arterial vessel arising from an inferior branch of the right renal artery. To the best of our knowledge, this is the initial documented instance of delayed bleeding manifesting eight years post-PCNL and angioembolization. This occurrence is exceptionally uncommon, given that the patient displayed no urological signs or symptoms throughout the intervening years, and no predictive or risk factors were identified.