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Risk Factors for Intra-operative Bleeding in Percutaneous Nephrolithotomy in an Academic Center: A Retrospective
Hamidreza Nasseh1, Gholamreza Mokhtari1, Samira Ghasemi2
1Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
Insights
Urinary tract infections and prior kidney surgeries increase bleeding risk during percutaneous nephrolithotomy (PNL). History of open surgery, nephrostomy, and ESWL are key risk factors for blood loss in PNL patients.
Area of Science:
- Urology
- Nephrology
- Surgical Oncology
Background:
- Percutaneous nephrolithotomy (PNL) is a preferred minimally invasive treatment for kidney stones.
- Bleeding is a significant complication associated with PNL procedures.
Purpose of the Study:
- To identify risk factors associated with bleeding during PNL.
- To analyze patient and surgical characteristics that correlate with blood loss.
Main Methods:
- Retrospective, descriptive, cross-sectional study design.
- Data collected from 151 patients undergoing PNL for staghorn calculi in a prone position.
- Analysis of demographics, surgical details, and outcomes, including hemoglobin drop.
Main Results:
- No significant correlation found between stone burden, age, BMI, GFR, surgery duration, or number of tracts and hemoglobin drop.
- Positive correlation identified between a history of Urinary Tract Infection (UTI) and hemoglobin drop (P=0.01).
- History of open kidney surgery (P=0.031), nephrostomy insertion (P=0.003), and extracorporeal shock wave lithotripsy (ESWL) (P=0.041) were associated with increased bleeding risk.
Conclusions:
- Urinary tract infection history is a significant risk factor for bleeding during PNL.
- Previous open kidney surgery, nephrostomy placement, and ESWL treatment are associated with increased bleeding risk in PNL.
- Identifying these risk factors can help improve patient management and outcomes in PNL.
Background:
Percutaneous nephrolithotomy (PNL) is the treatment of choice for renal stones as a safe, effective, and minimally invasive method. However, bleeding remains a major concern in the procedure.
Objectives:
This study aimed to investigate the risk factors of bleeding in PNL.
Methods:
This retrospective descriptive cross-sectional study was conducted in the Urology department of Razi hospital. The data of patients with urinary calculi staghorn type who underwent PNL in a prone position under general anesthesia were recorded. A checklist including patients' demographics, surgical characteristics, and outcomes was filled out for each patient.
Results:
The data from 151 complete files were gathered. The mean age of the cases was 47.89 ± 12.41 years. The mean hemoglobin (Hb) drop was 1.92 ± 1.56 mg/dL. At least 1 mg/dL Hb drop was observed in all cases. The highest Hb drop was 3 mg/dL.). There was no significant relationship between stone bulk, age, BMI, GFR, surgery duration, and the number of tracts, and Hb drop during PNL (P > 0.05). But there was a positive correlation between Urinary Tract Infection (UTI) history (P = 0.01) and transfusion (P = 0.0001) and Hb drop during PNL. Also, the history of open kidney surgery (P = 0.031), nephrostomy insertion (P = 0.003), and extracorporeal shock wave lithotripsy therapy (ESWL) (P = 0.041) were correlated with the increased risk of Hb drop.
Conclusions:
Urinary tract infection, history of open surgery, nephrostomy implantation, and ESWL were significantly associated with more bleeding in PNL.
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