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Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
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Updated: Mar 6, 2026

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Percutaneous nephrolithotomy; alarming variables for postoperative bleeding.

Shakhawan H A Said1, Mohammed A Al Kadum Hassan1, Rawa H G Ali1

  • 1Department of Urology, Sulaymaniyah Surgical Teaching Hospital, Sulaymaniyah, Iraq.

Arab Journal of Urology
|March 10, 2017
PubMed
Summary
This summary is machine-generated.

Percutaneous nephrolithotomy (PCNL) bleeding risk increases with complex stones (Guy's Stone Score 3-4), prior kidney surgery, and intraoperative perforations. These factors require careful consideration for managing PCNL complications.

Keywords:
BMI, body mass indexBleedingComplicationsGSS, Guy’s Stone ScoreHb, haemoglobinKUB, plain abdominal radiograph of the kidneys, ureters and bladderOR, odds ratioPCNL, percutaneous nephrolithotomyPercutaneous nephrolithotomyRenal stonesUS, ultrasonography

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Area of Science:

  • Urology
  • Nephrology
  • Surgical Complications

Background:

  • Bleeding is a significant complication of percutaneous nephrolithotomy (PCNL).
  • Prompt management of PCNL-related bleeding is crucial for patient outcomes.
  • Identifying predictive factors for bleeding can improve surgical planning and patient safety.

Purpose of the Study:

  • To identify preoperative and operative factors associated with bleeding after PCNL.
  • To evaluate the impact of stone complexity and surgical details on post-PCNL hemorrhage.
  • To inform strategies for managing bleeding complications following PCNL.

Main Methods:

  • Prospective collection of data from 200 patients undergoing unilateral PCNL over 20 months.
  • Analysis of demographic, preoperative, operative, and postoperative variables.
  • Inclusion of factors such as age, BMI, comorbidities, stone characteristics (Guy's Stone Score), surgical approach, and intraoperative complications.

Main Results:

  • Age, sex, BMI, diabetes, hypertension, and elevated creatinine did not significantly impact blood loss.
  • Increased bleeding risk was associated with a history of previous open renal surgery, intraoperative pelvicalyceal perforations, and Guy's Stone Score grades 3 and 4.
  • Multivariate analysis confirmed stone complexity, prior surgery, and perforations as significant predictors.

Conclusions:

  • Stone complexity (GSS grades 3-4), history of ipsilateral renal stone surgery, and intraoperative pelvicalyceal perforation are key risk factors for post-PCNL bleeding.
  • These identified variables serve as important indicators for heightened bleeding risk.
  • Awareness of these factors aids in proactive management and risk mitigation for PCNL procedures.