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Urinary Tract Calculi VI: Surgical Management01:25

Urinary Tract Calculi VI: Surgical Management

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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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Urinary Tract Calculi III: Medical Management01:30

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The diagnosis of renal calculi involves several imaging techniques, including non-contrast CT scans and ultrasound. These methods help visualize kidney stones, assess their size and location, and detect possible obstructions. Additionally, Measuring urine pH is useful for diagnosing specific stone types, such as struvite (alkaline pH) and uric acid stones (acidic pH). Cystine stones are primarily linked to cystinuria, a genetic condition. A urinalysis helps detect blood in the urine (hematuria)...
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Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
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Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
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Cardiac catheterization is an invasive diagnostic technique used to identify and evaluate structural and functional diseases of the heart and major blood vessels. This technique diagnoses congenital heart disease, coronary artery disease, valvular heart disease, and coronary spasms and assesses ventricular function. It helps guide treatment decisions, including the need for revascularization procedures like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) and...
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Updated: Jul 12, 2025

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Tranexamic acid for percutaneous nephrolithotomy.

Brent Cleveland1,2, Brett Norling3, Hill Wang3

  • 1Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA.

The Cochrane Database of Systematic Reviews
|October 26, 2023
PubMed
Summary
This summary is machine-generated.

Systemic tranexamic acid (TXA) may reduce blood transfusions and complications during percutaneous nephrolithotomy (PCNL) for kidney stones. However, it might increase adverse events, with uncertain effects on other outcomes.

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Area of Science:

  • Urology
  • Nephrology
  • Pharmacology

Background:

  • Percutaneous nephrolithotomy (PCNL) is standard for large kidney stones but carries bleeding risks.
  • Tranexamic acid (TXA) is an antifibrinolytic agent used to mitigate bleeding complications.

Approach:

  • Systematic review and meta-analysis of 10 randomized controlled trials (RCTs) involving 1883 participants.
  • Assessed effects of systemic TXA versus placebo in PCNL procedures.
  • Analyzed outcomes including blood transfusion, stone-free rate (SFR), thromboembolic events (TEEs), and complications.

Key Points:

  • Systemic TXA may reduce blood transfusions (low certainty of evidence).
  • May improve stone-free rates (low certainty of evidence).
  • Likely reduces major and minor surgical complications (moderate to low certainty of evidence).
  • May increase adverse events (low certainty of evidence).
  • No significant difference in thromboembolic events (moderate certainty of evidence).

Conclusions:

  • Systemic TXA in PCNL may offer benefits in reducing transfusions and complications, alongside improved SFRs.
  • Potential increase in adverse events warrants consideration.
  • Methodological limitations in RCTs impact the certainty of evidence, necessitating informed clinical decisions.