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Percutaneous nephrolithotomy in hypertensive patients with different sizes of instruments
B Resorlu1, C Kara, E Ozyuvali
1Kecioren Training and Research Hospital, Department of Urology, Ankara, Turkey. drberkan79@gmail.com
Insights
Percutaneous nephrolithotomy (PCNL) using smaller instruments is safe for hypertensive patients. This approach reduces hospital stay and bleeding complications compared to traditional PCNL methods.
Area of Science:
- Urology
- Nephrology
- Surgical Innovation
Background:
- Hypertensive patients face increased surgical risks, particularly hemorrhage.
- Percutaneous nephrolithotomy (PCNL) is a common procedure for kidney stones.
Purpose of the Study:
- To evaluate the safety and efficacy of PCNL in hypertensive patients using varying instrument sizes.
- To compare complication rates and outcomes based on device size.
Main Methods:
- Retrospective review of 53 hypertensive patients undergoing PCNL.
- Patients categorized into three groups based on instrument size (22F, 24F, 26F nephroscopes).
- Comparison of baseline characteristics, operative parameters, stone clearance, complications, and hospitalization length.
Main Results:
- No significant differences in age, gender, weight, or stone laterality across groups.
- Similar fluoroscopy time, access, and operative time per stone volume.
- Higher hemoglobin decrease, longer hospital stay, and increased blood transfusion rates in the largest instrument group (30F tract/26F nephroscope).
- Stone-free rates were high across all groups, with adjunctive therapy.
Conclusions:
- PCNL with smaller instruments (22F-26F) is safe and effective in hypertensive patients.
- Smaller devices are associated with reduced bleeding and shorter hospital stays compared to larger instruments.
- This suggests a preference for smaller caliber PCNL in hypertensive individuals.
Objectives:
The risk of major complications, especially hemorrhage, is significantly elevated during surgery in hypertensive patients. To determine whether percutaneous nephrolithotomy (PCNL) can be safely performed in the hypertensive patients using different sized instruments.
Methods:
We reviewed the records of 602 patients undergoing PCNL at our institution and identified 53 who were on antihypertensive therapy at the time of surgery. Patients were categorized into three groups according to size of devices used in surgery : those 24 F percutaneous tract with 22 F nephroscope (Group 1, n = 12 [22.7%]; 26 F percutaneous tract with 24 F nephroscope (Group 2, n = 19 [35.8%]) and 30 F percutaneous tract with 26 F nephroscope (Group 3, n = 22 [41.5%]). We compared the groups with regard to baseline characteristics, intraoperative parameters, stone-free and complication rates, and the length of hospitalization.
Results:
There were no differences between the three groups in age, gender, weight and stone laterality. Fluoroscopy time, access to the collecting system and mean operative time for per cm2 stone did not differ between the groups. Hemoglobin decrease, postoperative hospital stay and blood transfusion rate was higher in group 3. Stones were completely cleared in 83.3%, 84.2% and 81.3% of patients, which increased to 91.6%, 89.5%, and 90.1% with adjunctive therapy in the group 1,2 and 3, respectively.
Conclusions:
PCNL with smaller devices is a safe and effective method in hypertensive patients. It has significantly a shorter hospital stay and less bleeding rates compared to classical PCNL.
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