Abstract / Summary
Percutaneous nephrostomy (PCN) is widely performed to drain upper urinary tract obstructions.Although hemorrhagic complications during PCN placement are well recognized, clinically significant bleeding immediately following nephrostomy tube removal has been rarely reported.A 76-year-old man with muscle-invasive bladder cancer and bilateral hydronephrosis underwent right-sided PCN for obstructive pyelonephritis using an 8.3-Fr JINRO™ nephrostomy catheter (Boston Scientific, Marlborough, MA, USA).He subsequently underwent radical cystectomy, pelvic lymph node dissection, and ileal conduit urinary diversion.The nephrostomy tube was removed on postoperative day 5. Immediately thereafter, substantial bleeding occurred from the nephrostomy tract and through the ileal conduit.Although the patient remained hemodynamically stable, his hemoglobin level decreased from 10.4 to 9.4 g/dL.External compression of the nephrostomy site was applied, and a Foley catheter balloon was temporarily inflated within the ileal conduit to occlude the conduit outlet.Contrast-enhanced computed tomography revealed no active extravasation but demonstrated a hematoma within the right renal pelvis.Approximately 300 g of bloody output containing blood clots was observed from the ileal conduit.Given the severity of the bleeding and concern for continued blood loss, four units of packed red blood cells were transfused.Hemostasis was achieved without transcatheter arterial embolization.This case highlights that clinically significant hemorrhage may occur immediately after nephrostomy tube removal.Although no conclusions regarding the efficacy or safety of specific tube-removal techniques can be drawn from a single case, this experience underscores the importance of careful observation after tube removal, along with prompt evaluation and management if significant bleeding occurs.