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Assessment of Pre-operative Factors Associated With Blood Loss in Patients Undergoing Percutaneous Nephrolithotomy: A
Deelip K Singh1, Sanjay Gupta1, Kumar Shubham2
1Urology, Indira Gandhi Institute of Medical Sciences, Patna, IND.
Insights
This study identified key factors predicting bleeding risk after percutaneous nephrolithotomy (PCNL). Larger kidney stone burden and horseshoe kidney presence are associated with increased bleeding, aiding in pre-operative risk assessment for PCNL patients.
Area of Science:
- Urology
- Nephrology
- Surgical Risk Assessment
Background:
- Percutaneous nephrolithotomy (PCNL) is a common procedure for kidney stone removal.
- Bleeding is a significant risk associated with PCNL, necessitating identification of predictive factors.
- Understanding pre-operative factors can improve patient safety and surgical planning.
Purpose of the Study:
- To evaluate pre-operative predictive factors for bleeding complications following percutaneous nephrolithotomy (PCNL).
- To identify patient characteristics associated with increased blood loss during and after PCNL.
- To enhance risk stratification for patients undergoing PCNL.
Main Methods:
- Prospective data collection from 193 patients undergoing PCNL between December 2019 and November 2021.
- Evaluation of hematuria and blood loss via urethral catheter and nephrostomy tube outputs post-procedure.
- Multivariate regression analysis to determine the association between blood loss and patient demographics/clinical characteristics.
Main Results:
- A higher mean hemoglobin level drop was observed in patients with a stone burden > 30 mm² (2.359 ± 1.822 g/dL) compared to those with smaller stones (1.859 ± 1.540 g/dL), P=0.0408.
- The presence of a horseshoe kidney was significantly associated with a higher risk of mean hemoglobin level drop (OR=0.071, P=0.036) in multivariate analysis.
- No statistically significant difference in hemoglobin drop was found across different age groups.
Conclusions:
- Increased kidney stone burden is a predictive factor for greater blood loss after PCNL.
- Horseshoe kidney anatomy is an independent risk factor for bleeding complications following PCNL.
- These findings can aid in pre-operative counseling and risk management for PCNL procedures.
Abstract:
Background One of the main risks associated with percutaneous nephrolithotomy (PCNL) is bleeding. In the present study, efforts are made to evaluate the pre-operative predictive factors contributing to bleeding due to the procedure of PCNL. Materials and methods From December 2019 to November 2021, data were collected prospectively from 193 patients undergoing PCNL procedures at Indira Gandhi Institute of Medical Sciences, Patna, India. Following PCNL, to check for hematuria and the extent of blood loss, the urethral catheter's and nephrostomy tube's outputs were evaluated. Multivariate regression analysis was used to evaluate the relationship between blood loss and a variety of patient-related demographic and clinical characteristics. Results Included in the study were 193 patients who underwent PCNL. Male patients made up the majority. The average age of study participants was 33.5 years. No statistically significant difference was reported in the mean hemoglobin level drop in the age groups of up to 25 years (2.211 ± 1.540 g/dL), 26-50 years (2.023 ± 1.882 g/dL), and > 50 years (1.855 ± 0.986 g/dL) with P = 0.64. The mean hemoglobin level drop in patients with stone burden > 30 mm2 was reported to be higher, 2.359 ± 1.822 g/dL, compared to 1.859 ± 1.540 g/dL in patients with lower stone burden, reaching a statistically significant difference (P =0.0408). By univariate regression analysis, the presence of a horseshoe-shaped kidney (odds ratio = -0.158, 95% confidence interval (CI): -0.911, -0.059; P = 0.026) was associated with a higher risk for a drop in mean hemoglobin level. By multivariate regression analysis, the presence of a horseshoe-shaped kidney (odds ratio = 0.071, 95% CI: 0.006, 0.839; P = 0.036) remained significantly and independently associated with a higher risk of a drop in mean hemoglobin level. Conclusion In conclusion, the patients' burden of stones and the presence of a horseshoe-shaped kidney may be associated with a higher risk of bleeding following PCNL.
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