Adult urologyPercutaneous Nephrolithotomy: Variables That Influence Hemorrhage
Section snippets
Material and Methods
From August 2002 to April 2005, 234 PCNL procedures were performed at our institution. Of these 234 patients, 41 had missing data, were lost to follow-up, or had undergone second-look PCNL procedures and were excluded from the study. The data from 193 primary PCNL procedures were prospectively recorded to a specific PCNL form (preoperative, operative, and postoperative details) for each patient. Then, the data from all 193 PNL procedures were retrospectively analyzed regarding hemorrhage. Blood
Results
Of 234 PCNL procedures, the data from 193 (193 patients) were available for analysis. The mean patient age was 45.7 ± 14.4 years (range 5 to 74). Of the 193 patients, 59 patients were female and 134 patients were male. None had any renal anomaly. Of the 193 patients, 67 (34.7%) had a history of stone intervention (previous PCNL, 22 patients; previous pyelolithotomy or nephrolithotomy, 45 patients). The stones were located in the right kidney in 92 and the left side in 101 patients.
The mean
Comment
PCNL is currently the procedure of choice for removal of large and complex renal stones. The most common minor complications of PCNL are pain (49%), fever (30%), urinary infection (11%), and renal colic (4%).8 The most common major complications of PCNL are septicemia (4.1%) and bleeding requiring blood transfusion (2.7%).8
Blood loss is a common occurrence during PCNL. It can present intraoperatively or postoperatively and can be severe enough to necessitate blood transfusion. However, the risk
Conclusions
Staghorn stones, the presence of diabetes, the use of multiple tracts, and large stones were associated with increased bleeding during PCNL on multivariate analysis in our study. However, balloon dilation was associated with decreased bleeding. The stone surface area and number of tracts correlated positively with regard to the hematocrit decrease. Endourologists should take into consideration the aforementioned factors before using PCNL. Prevention, rather than treatment, is the rule in
References (18)
- et al.
Percutaneous renal calculus removal in an extracorporeal shock wave lithotripsy practice
J Urol
(1987) - et al.
Percutaneous nephrolithotomy and its legacy
Eur Urol
(2005) - et al.
Estimated blood loss and transfusion rates associated with percutaneous nephrolithotomy
J Urol
(1994) - et al.
Management of hemorrhage after percutaneous renal surgery
J Urol
(1995) - et al.
Stone surface area determination techniques: a unifying concept of staghorn stone burden assessment
J Urol
(1992) - et al.
Percutaneous removal of kidney stones: review of 1,000 cases
J Urol
(1985) - et al.
The etiology and treatment of delayed bleeding following percutaneous lithotripsy
J Urol
(1985) Percutaneous punctures—is this the endourologist’s turf?
J Urol
(1994)- et al.
Endoscopic surgery for renal calculi
Cur Opin Urol
(2003)