Persistent hematuria after PCNL: a rare case report of renal pseudoaneurysm managed with endovascular coil embolization in Indonesia

Introduction: Percutaneous nephrolithotomy (PCNL) is a standard treatment for renal stones, but delayed hemorrhage from renal artery pseudoaneurysm (RAP) remains a rare yet serious complication. Early diagnosis and intervention are essential to prevent hemodynamic failure and renal loss. We present an uncommon case of a renal pseudoaneurysm developing after PCNL. Presentation of case: A 64-year-old male presented with recurrent gross hematuria 1 month after PCNL. He had prior episodes of clot retention requiring cystoscopy and multiple transfusions. On admission, he exhibited persistent hematuria, anemia, and impaired renal function. CT angiography revealed a suspected vascular injury in the posteroinferior aspect of the right kidney. Cystoscopy showed no urological source of bleeding, raising suspicion of a vascular lesion. Selective renal angiography confirmed a pseudoaneurysm of the posteroinferior segmental artery, which was successfully treated using super-selective coil embolization. At follow-up, hematuria resolved completely, and renal function stabilized. Discussion: Delayed hematuria after PCNL should raise a concern for RAP, particularly when endoscopic evaluation is negative. Selective angioembolization offers an effective, nephron-sparing control of bleeding with low morbidity. Conclusion: Selective coil embolization is a safe and effective first-line treatment for post-PCNL pseudoaneurysm. Early imaging and prompt management are crucial to prevent severe complications and preserve renal function.