Effect of shockwave lithotripsy before percutaneous nephrolithotomy on the risk of renal arteriovenous fistula.

Abstract

Introduction: This study aimed to assess the impact of shockwave lithotripsy (SWL) on the incidence of renal arteriovenous fistula (AVF) following percutaneous nephrolithotomy (PCNL).

Methods: We retrospectively analyzed data from patients who underwent PCNL and/or SWL for kidney stones, as well as angioembolization for renal AVF, between January 2000 and December 2024. Patients with inadequate followup or insufficient medical records were excluded. Patients were divided into two groups: the first group included those who did not undergo SWL before PCNL, while the second group included those who underwent SWL. Various patient factors, stone characteristics, and surgical features were compared between the groups.

Results: We reviewed data from 851 PCNL patients, 3043 SWL patients, and 31 patients who underwent angioembolization for renal AVF. Fourteen patients were excluded due to insufficient data. A total of seventeen patients (1.2%) developed renal AVF after PCNL, with 13 (76.5%) of them having undergone prior SWL at the same renal unit. In the group with a history of SWL before PCNL, the odds ratio calculated for the occurrence of AVF was 190.4 (95% confidence interval 55.1-657.1, p<0.001).

Conclusions: AVF is a serious complication that occurs after vascular damage. Both SWL and PCNL are among the treatments that can cause this complication. Due to their additive effects, performing SWL and PCNL consecutively in a short period appears to increase the risk of developing AVF. Careful patient management is essential to minimize this risk.