A 76-year-old man experienced a hemoglobin drop from 10.4 to 9.4 g/dL and a hematoma within the right renal pelvis following the removal of a nephrostomy tube on postoperative day five. Published medical case reports in late 2026 outline severe hemorrhagic and extravasation hazards during urological procedures.
Percutaneous nephrostomy is used for draining upper urinary tract obstructions caused by malignant diseases, urinary calculi, and benign ureteral strictures. While hemorrhagic complications during initial catheter placement are widely recognized, clinically significant bleeding immediately following the removal of a nephrostomy tube is rarely documented in medical literature. A clinical report published in Cureus details an instance where a patient undergoing treatment for muscle-invasive bladder cancer suffered internal bleeding right after tube extraction.
Surgical Intervention And Postoperative Hemorrhage In Bladder Cancer Treatment
The patient initially presented with asymptomatic gross hematuria and hypertension without antiplatelet or anticoagulant therapy. Preoperative magnetic resonance imaging suggested cT3a bladder cancer, while computed tomography confirmed cN0M0 disease accompanied by bilateral hydronephrosis. Transurethral resection of the bladder tumor preceded a pathological examination revealing grade 3 urothelial carcinoma according to the 1973 World Health Organization grading system, with invasion into the muscularis propria aligning with at least pT2 under TNM classification. Subsequent right-sided obstructive pyelonephritis required a right percutaneous nephrostomy using an 8.3-Fr JINRO™ nephrostomy catheter manufactured by Boston Scientific in Marlborough, MA, USA. Clinicians performed the placement under ultrasound and fluoroscopy without Doppler imaging, noting a small amount of bleeding through the puncture needle before successfully inserting the catheter.
Five days after the drainage procedure, the patient underwent a radical cystectomy, pelvic lymph node dissection, and ileal conduit urinary diversion. The total operative time reached 261 minutes, with an estimated blood loss of 610 mL. Final pathology confirmed urothelial carcinoma categorized as pT3aN0. Medical staff clamped the nephrostomy tube after cystectomy and removed it on postoperative day five, exactly 10 days after the initial catheter placement. Substantial bleeding emerged from the nephrostomy tract and through the ileal conduit. Although the patient maintained hemodynamic stability, his hemoglobin plummeted from 10.4 to 9.4 g/dL. Medical teams applied external compression to the nephrostomy site and temporarily inflated a Foley catheter balloon inside the ileal conduit to block the outlet. Contrast-enhanced computed tomography showed no active vascular extravasation but exposed a hematoma situated within the right renal pelvis, accompanied by approximately 300 grams of bloody output and blood clots discharged from the conduit. Clinicians administered four units of packed red blood cells to counter the blood loss, achieving hemostasis successfully without resorting to transcatheter arterial embolization.
Renal Rupture And Intrarenal Pressure Risks In Ureteroscopic Lithotripsy
Separate clinical findings examine four patients who suffered renal rupture and massive urinary extravasation following retrograde intrarenal surgery with holmium laser lithotripsy. While retrograde intrarenal surgery serves as a minimally invasive approach for upper urinary tract calculi, it carries mechanical risks driven by elevated intrarenal pressure. Normal physiological pressure in an unobstructed kidney measures between zero and 15 mmHg, but endoscopic procedures push pressures past dangerous thresholds, causing pyelorenal backflow, forniceal rupture, and parenchymal injury. Primary contributing factors identified across these four cases included pre-existing moderate-to-severe hydronephrosis with parenchymal thinning, duplicated kidneys, prior renal surgeries, and prolonged operative durations lasting between 2.5 and 3.7 hours.
Emergency medical interventions for these four cases involved broad-spectrum antibiotics, fluid resuscitation, percutaneous drainage of ascites pulling 1,000 to 1,200 mL within 30 minutes where relevant, and selective renal artery embolization to treat active bleeding in one patient. Published literature recommendations suggest that maintaining intrarenal pressure below the commonly cited threshold of 30 mmHg, restricting operative times to 60 to 90 minutes, and utilizing preoperative ureteral stenting for seven to 14 days represent preventive measures against ureteroscopic complications.
Surgical Teams Must Monitor Patients After Nephrostomy Tube Removal
Both clinical reports emphasize that severe urological bleeding and renal trauma require vigilance from surgical teams. While the nephrostomy tube removal case yielded recovery following a four-unit blood transfusion, authors noted that no generalized conclusions regarding specific tube-removal techniques can be drawn from a single patient experience. The event demonstrates the necessity of attentive monitoring immediately following nephrostomy catheter withdrawal. Similarly, the retrospective analysis of four renal rupture cases stresses that early recognition, intensive care support, and multidisciplinary collaboration remain vital for patient survival when managing severe renal rupture and massive urine extravasation following retrograde intrarenal surgery.