To explore the causes of severe bleeding after retrograde intrarenal surgery and explore the feasibility of related treatment methods and strategies.

The general data and preoperative and postoperative clinical data of patients with severe bleeding after retrograde intrarenal surgery in the First Affiliated Hospital of Guangzhou Medical University from 2022 to 2023 were retrospectively collected and analyzed, and the causes of bleeding and the feasibility of treatment strategies were analyzed.

Among the 5 patients, 3 cases did not experience any further bleeding after renal artery embolization treatment. One patient who underwent renal artery embolization three times and then underwent nephrostomy successfully stopped bleeding. Another patient continued to experience bleeding after two rounds of renal artery embolization, and underwent another embolization procedure after nephrostomy. No further bleeding occurred thereafter. During the hemostasis period, a combination of fluid replacement, blood transfusion, anti infection, continuous bladder irrigation, and other treatments were used, and ultimately all patients improved and were discharged.

The bleeding after retrograde intrarenal surgery is characterized by multiple blood vessel injuries. The cause of bleeding is not completely clear at present, and may be related to elevated renal pelvis pressure, false aneurysm formation and other reasons. Nephrostomy alleviates the intrarenal pressure and subsequent embolization of renal artery is effective in the treatment of bleeding.