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

Area of Science:

• Urology
• Nephrology
• Surgical Complications

Background:

• Percutaneous nephrolithotomy (PCNL) is a primary treatment for large upper urinary tract stones.
• Severe bleeding is a significant perioperative complication of PCNL, impacting patient recovery.
• Existing studies on PCNL bleeding risk factors lack consistency, necessitating further investigation.

Purpose of the Study:

• To conduct a meta-analysis to identify and assess risk factors for severe bleeding complications associated with PCNL.
• To provide a comprehensive overview of factors influencing bleeding during PCNL procedures.

Main Methods:

• A systematic literature search was performed across major databases (PubMed, Embase, Web of Science, Cochrane Library) up to May 1, 2025.
• Included studies were case-control in design.
• Statistical analysis was conducted using Revman 5.4 software.

Main Results:

• The meta-analysis included 22 studies with 878 severe bleeding cases and 10,746 controls.
• Identified risk factors for severe bleeding include: diabetes, hypertension, urinary tract infection, renal anomaly, multiple stones, larger stone size, staghorn stones, solitary renal stones, multiple accesses, and longer operative time.
• Hydronephrosis was found to be a protective factor against severe bleeding.

Conclusions:

• Several factors, including patient comorbidities (diabetes, hypertension, UTI), stone characteristics (size, type, number), and procedural elements (multiple accesses, operative time), are significantly associated with severe bleeding in PCNL.
• Hydronephrosis may reduce the risk of severe bleeding.
• Clinical attention and early intervention for these identified factors are crucial for improving patient safety and reducing severe bleeding complications during PCNL.