Risk factors for severe bleeding associated with percutaneous nephrolithotomy: A meta-analysis

Percutaneous nephrolithotomy (PCNL) is commonly used for the treatment of large loads of upper urinary tract stones. Bleeding is one of the major complications of PCNL, and severe bleeding affects patient life and recovery in the perioperative period. There are few high-quality studies on the risk factors for severe bleeding with PCNL, and the conclusions of multiple studies are not entirely consistent. This study assessed the risk factors for severe bleeding complications associated with PCNL through a meta-analysis.

Computer-based search of PubMed, Embase, Web of Science, and The Cochrane Library were conducted, with the search period ranging from the establishment of the databases to May 1, 2025. Statistical analysis was performed using Revman 5.4 software.

A total of 22 studies were included, all of which were case-control studies, with 878 cases in the severe bleeding group and 10,746 cases in the control group. Meta-analysis showed that the combination of diabetes (odds ratios [OR] = 3.27, 95% confidence interval [CI], 2.45-4.37), hypertension (OR = 2.39, 95% CI, 1.68-3.42), urinary tract infection (OR = 1.91, 95% CI, 1.30-2.81), renal anomaly (OR = 3.99, 95% CI, 2.22-7.16), multiple stones (OR = 2.10, 95% CI, 1.08-4.11), stone size (mean difference = 0.64, 95% CI, 0.03-1.25), staghorn stones (OR = 2.73, 95% CI, 2.15-3.47), solitary renal stones (OR = 3.60, 95% CI, 1.91-6.76), multiple accesses (OR = 3.94, 95% CI, 2.46-6.34), and operative time (mean difference = 22.11, 95% CI, 12.96-31.26) were the risk factors for severe bleeding associated with PCNL (P < .05). Hydronephrosis (OR = 0.36, 95% CI, 0.18-0.75) was a protective factor for severe bleeding with PCNL (P < .05).

Diabetes, hypertension, urinary tract infections, renal anomaly, hydronephrosis, number of stones, stone size, staghorn stones, solitary renal stones, number of access, and operative time are associated with PCNL complicating severe bleeding, which requires clinical attention. Early identification and intervention for these factors are necessary to reduce the incidence of severe bleeding complications during PCNL and improve perioperative patient safety.