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Published on: July 31, 2016
Blood transfusion, embolisation and nephrectomy after percutaneous nephrolithotomy (PCNL)
Stephen R Keoghane1, Richard J Cetti, Ann E Rogers
1Department of Urology, Queen Alexandra Hospital, Portsmouth, UK. Stephen.Keoghane@porthosp.nhs.uk
Insights
Percutaneous nephrolithotomy (PCNL) carries risks, but this UK study shows low vascular complication rates. Higher transfusion risk is linked to older age, longer procedures, and urinary tract infections, supporting centralized stone surgery.
Area of Science:
- Urology
- Nephrology
- Surgical Outcomes
Background:
- Percutaneous nephrolithotomy (PCNL) is a key treatment for renal stones but has associated morbidity.
- Contemporary data on vascular complications and Intensive Care Unit (ICU) admissions after PCNL is crucial for patient consent and quality improvement.
Purpose of the Study:
- To audit the outcomes of PCNL over a decade at a UK centre.
- To provide contemporary data on blood loss and vascular risk for patients undergoing PCNL.
- To evaluate factors associated with transfusion and vascular complications.
Main Methods:
- Retrospective analysis of 568 PCNL procedures performed between April 2000 and December 2010.
- Statistical analysis of the association between transfusion and patient age, operative duration, and preoperative urinary tract infection (UTI).
- Review of vascular complications including angiography and embolisation.
Main Results:
- 3.8% of adult patients required blood transfusion, with increased risk in older patients, longer operative times, and positive preoperative urine samples.
- Seven patients (1.2%) required angiography, with five (0.9%) undergoing embolisation for vascular complications.
- No deaths occurred, but one patient (0.2%) needed an emergency nephrectomy due to bleeding complications.
Conclusions:
- This large UK series provides contemporary data on vascular risk associated with PCNL.
- Transfusion risk is associated with patient age, operative duration, and preoperative UTI.
- Outcomes compare favorably with international data, supporting the centralisation of specialist stone surgery.
Unlabelled:
WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Percutaneous treatment for renal stone disease is associated with a risk of significant morbidity. Our large UK series provides contemporary data on the risk of vascular complications and admission to the Intensive Care Unit (ICU) after PCNL. When compared with recent international databases, these data support the current evidence that better outcomes can be achieved in centres performing large numbers of procedures. These data add to the debate for the centralisation of specialist stone surgery.
Objective:
To audit the outcome of percutaneous nephrolithotomy (PCNL) at a UK stone centre over a 10-year period, and provide patients with understandable contemporary data on blood loss and vascular risk.
Patients And Methods:
A single centre retrospective analysis of all PCNLs undertaken between April 2000 and December 2010. The association between transfusion and patient age, operative duration and positive preoperative mid-stream urine (MSU) sample was subject to statistical analysis.
Results:
Data on 568 patients was analysed. 21 were paediatric cases with a mean (range) age of 8 (2-16) years; 547 were adult cases with a mean (range) age of 55 (17-84) years. 3.8% of adult patients (21/547) received a blood transfusion; mean age 60 years (55 years in those not transfused) with a mean operative duration of 119 min (103 min in those not transfused). 23.8% of patients transfused had a confirmed preoperative urinary tract infection compared with 16.1% of those not transfused. Seven patients underwent angiography, with five having selective arterial embolisation (0.9%). There were no deaths in this series although one patient (0.2%) required an urgent nephrectomy due to cardiovascular instability from bleeding.
Conclusions:
Large UK series that provides contemporary data for consent on vascular risk at PCNL. The risk of transfusion is associated with increased patient age, operative duration and the presence of a positive preoperative MSU sample. Data compares favourably with other large published series, and supports the argument for centralisation of percutaneous stone management.
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