Factors affecting bleeding during percutaneous nephrolithotomy: single surgeon experience.

Area of Science:

• Urology
• Nephrology
• Surgical Research

Background:

• Percutaneous nephrolithotomy (PCNL) is a key procedure for kidney stone removal.
• Understanding factors influencing bleeding is crucial for patient safety and optimizing outcomes.
• Bleeding remains a significant complication in PCNL.

Purpose of the Study:

• To identify variables associated with bleeding during PCNL.
• To analyze the impact of surgical experience on bleeding complications.
• To provide insights for improving PCNL safety and efficacy.

Main Methods:

• Retrospective review of 649 PCNL procedures performed by a single surgeon.
• Analysis of patient factors (age, diabetes, hypertension), stone characteristics (type, surface area), and operative factors (time, accesses).
• Statistical analysis using univariate and multivariate regression models to assess bleeding predictors.

Main Results:

• The study found that multiple access tracts, staghorn calculi, diabetes, and operative time were significant predictors of blood loss.
• A prolonged operative time (cutoff of 58 minutes) was associated with increased transfusion risk.
• Importantly, surgical experience was not found to correlate with decreased hemoglobin levels or transfusion necessity.

Conclusions:

• Multiple access tracts, staghorn calculi, diabetes, and prolonged operative time significantly increase blood loss during PCNL.
• Surgical experience, in this single-surgeon cohort, did not emerge as a significant factor influencing bleeding.
• These findings highlight modifiable operative and patient factors that can be targeted to minimize bleeding in PCNL.