[Hemorrhagic complications risk forecast of operative treatment of urolithiasis]

In the structure of hospital urological pathology, urolithiasis is about 40%, while 2/3 of patients are hospitalized for emergency reasons. Surgical treatment, even in a modern minimally invasive format, can cause postoperative complications in 10-30% of cases, of which up to 5% are hemorrhagic complications requiring blood transfusion in 0.7-1.4% of cases.

To determine the diagnostically significant risk factors for postoperative bleeding, the results of treatment of urolithiasis in 574 patients using remote lithotripsy were used. Based on the results of the statistical analysis, a computer program module "Method for predicting the development of hemorrhagic complications of the postoperative period in patients with urolithiasis" was developed.

Of the 45 alleged risk factors for postoperative bleeding, 9 diagnostically significant ones were selected, including recurrent urolithiasis, a history of bleeding, hematuria, size and density of the calculus, and some indicators of the coagulogram. The threshold value of the amount of bleeding risk assessment in points is set to 8, that is, a result of more than 8 points corresponds to a high risk of bleeding. It was established that the risk of hemorrhagic complications in the postoperative period in urolitiasis increases with large stones (size from 5 mm) with high density (from 400 HU), with a decrease in the number of platelets (from 1701012/l) and lengthening of AChTV (from 40 c), PV (from 15 s) and TV (from 16 s), as well as in the presence of a history of recurrent urolithiasis, bleeding and preoperative microhematuria.

The developed computer program module allows you to quickly and objectively assess the risk of hemorrhagic complications at the stage of choosing the method of surgery, conduct preoperative prophylaxis and increase the effectiveness of surgical treatment of urolithiasis.