Delayed Post-percutaneous Nephrolithotomy Hemorrhage Managed With Superselective Renal Artery Embolization: A Nephron-Sparing Therapeutic Approach

Percutaneous nephrolithotomy (PCNL) is the preferred treatment for large renal stones, though delayed arterial bleeding is a rare but serious complication. A 59-year-old male, previously discharged post-PCNL, presented on postoperative day 10 with gross hematuria and clot retention. CT angiography confirmed an interpolar segmental artery pseudoaneurysm. Superselective renal artery embolization (SSAE) with n-butyl cyanoacrylate achieved hemostasis without transfusion. Renal function was preserved, and the patient recovered uneventfully. The patient was reviewed after two weeks for follow-up after SSAE. This case illustrates the value of prompt vascular imaging in delayed post-PCNL bleeding and highlights the role of superselective renal artery angioembolization as a safe, effective, nephron-sparing intervention in modern endourological practice.