[Lower massive hematuria deferred by arteriovenous fistula following percutaneous nephrostomy].

Objectives: To report one case of severe lower hematuria 48 hours after urinary diversion by percutaneous nephrostomy for obstructive uropathy.

Methods: The clinical picture, its severity, and previous procedure probably causing it made the study by arteriography essential to identify the existence of an arteriovenous fistula after stabilization of the acute anaemia; it was confirmed and selective embolization was undertaken with an optimal result. We performed a bibliographic search on Pub-Med (MEDLINE) using the terms "percutaneous nephrostomy", "complications", and "arteriovenous fistula". Most published papers are case reports and series of nephrostomies analyzing their complications and the management of them.

Results: Complications attributable to percutaneous nephrostomy are very rare varying from pneumothorax/hydrothorax, infection, perforation and injuries to neighbour organs, allergic reactions to contrasts, urinomas, to pictures of mild to severe hematuria due to vessel laceration and arteriovenous fistula, either high or through bladder. In the case we report as well as in those from the literature, initial treatment of hematuria was watchful waiting; only severity or persistence for more than 3-4 days should make to suspect the existence of arteriovenous fistula, and then arteriography is mandatory to obtain confirmation and if possible treat it by selective embolization; there are various materials to do it. Clinical repercussion was severe but thanks to radiological interventional techniques the case was solved with preservation of the renal unit.

Conclusions: Complications after percutaneous nephrostomy are very rare, and the clinical picture alerts about the possibility of some of them. Radiological tests allow to identify the great majority of them and to perform an effective treatment.