Int Urol Nephrol. 2026 Jan 14. doi: 10.1007/s11255-026-05015-5. Online ahead of print.
ABSTRACT
BACKGROUND: Vascular complications following percutaneous nephrolithotomy (PCNL), although uncommon, may result in significant morbidity. This systematic review and meta-analysis evaluated the incidence, distribution, and management outcomes of vascular complications after PCNL in contemporary practice.
METHODS: A systematic search of PubMed/MEDLINE, EMBASE, BIOSIS, Google Scholar, and the Cochrane Library identified observational studies reporting vascular complications after PCNL published between 2015 and 2025. Pooled proportions were calculated using a DerSimonian-Laird random-effects model. Statistical heterogeneity was assessed using the I2 statistic, and methodological quality was evaluated using the Newcastle-Ottawa Scale. This review was not prospectively registered.
RESULTS: Ten studies met the inclusion criteria. Four studies reporting denominator-level data (10,440 PCNL procedures) were included in the pooled incidence analysis, yielding a vascular complication incidence of 3% (95% CI 2-4%). Among 625 reported vascular complications, pseudoaneurysms were the most frequent lesion (57%), followed by arteriovenous fistulas (29%), arterial lacerations (25%), and arteriocaliceal fistulas (11%); lesion categories were not mutually exclusive. Nine studies reported outcomes following angioembolization (703 cases) and two studies reported conservative management outcomes (204 cases). The pooled success rate was 92% (95% CI 84-98%) for angioembolization and 67% (95% CI 52-80%) for conservative management (p = 0.0013). No procedure-related mortality was reported.
CONCLUSIONS: Vascular complications after PCNL remain infrequent in contemporary practice but may be clinically significant when they occur. Pseudoaneurysm is the most reported lesion. Angioembolization is associated with high success rates in appropriately selected patients, while conservative management remains effective in selected cases. Interpretation of these findings should consider the observational nature of the evidence and substantial heterogeneity across studies.
PMID:41533282 | DOI:10.1007/s11255-026-05015-5
