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Predictive factors for percutaneous nephrolithotomy bleeding risks.

U Phun Loo1, Chun Hou Yong1, Guan Chou Teh1

  • 1Urology Department, Sarawak General Hospital, Kuching, Malaysia.

Asian Journal of Urology
|February 5, 2024
PubMed
Summary

Predictors for bleeding during percutaneous nephrolithotomy (PCNL) were identified. Absence of hypertension, specific puncture site, and longer operative duration were linked to greater blood loss, though effects were small.

Keywords:
BleedingBlood lossPercutaneous nephrolithotomyPredictive factorRisk factor

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Area of Science:

  • Urology
  • Nephrology
  • Surgical Risk Assessment

Background:

  • Percutaneous nephrolithotomy (PCNL) is a key procedure for kidney stones.
  • Minimizing bleeding risk in PCNL is crucial for patient safety and outcomes.
  • Identifying predictive factors can improve risk stratification for PCNL procedures.

Purpose of the Study:

  • To identify factors predicting bleeding risk during percutaneous nephrolithotomy (PCNL).
  • To enable better risk stratification and early identification of high-risk patients for PCNL.

Main Methods:

  • Prospective observational study of adult patients undergoing PCNL for radio-opaque renal stones.
  • Exclusion criteria included coagulopathy and planned additional procedures.
  • Stepwise multivariate regression analysis was used to assess factors like comorbidities, BMI, stone burden, puncture site, tract size, operative position, surgeon seniority, and duration on hemoglobin deficiency.

Main Results:

  • 4.86% of patients required packed red blood cell transfusion.
  • Significant associations with higher estimated hemoglobin deficiency were found for absence of hypertension (p=0.024), puncture site (p=0.027), and operative duration (p=0.023).
  • Effect sizes were small, and other studied factors did not correlate with hemoglobin difference.

Conclusions:

  • Hypertension, puncture site, and operative duration significantly impact estimated hemoglobin deficiency in PCNL, but with small effect sizes.
  • Operative position, puncture number, and tract dilatation size did not correlate with blood loss.
  • Meticulous operative technique remains paramount; PCNL can be safely performed by trainees in selected patients.