Elsevier

Urology

Volume 69, Issue 4, April 2007, Pages 603-607
Urology

Adult urology
Percutaneous Nephrolithotomy: Variables That Influence Hemorrhage

https://doi.org/10.1016/j.urology.2006.12.021Get rights and content

Objectives

Renal hemorrhage is one of the most common and worrisome complications of percutaneous nephrolithotomy (PCNL). This study attempted to identify variables that might influence hemorrhage during PCNL to help urologists establish preventative and treatment strategies for bleeding during PCNL procedures.

Methods

The data of 193 patients (193 PCNL procedures) were retrospectively analyzed. Hemorrhage was estimated by the postoperative decrease in hematocrit factored by the quantity of any blood transfusion. Various preoperative and operative factors were assessed for their association with blood loss using univariate, forward multivariate regression and correlation analysis.

Results

The mean patient age was 45.7 ± 14.4 years (range 5 to 74). The overall stone-free rate was 85.4%. The average hematocrit decrease was 8.7% ± 5.39% (range 0.3 to 24.7). Forward multivariate regression analysis identified five significant variables that influenced PCNL-related hemorrhage: stone type (P = 0.003), number of tracts (P = 0.010), method of dilation (P = 0.010), diabetes (P = 0.022), and stone surface area (P = 0.049). A statistically significant difference was found in relation to the occurrence of hemorrhage between patients with caliceal stones and partial staghorn stones (P = 0.008) and complete staghorn stones (P = 0.006), single tracts and multiple tracts (P = 0.038), balloon dilators and Amplatz dilators (P = 0.007), patients with small stones (1000 mm2 or smaller) and large stones (greater than 1000 mm2; P = 0.018) on univariate analysis. Also, the stone surface area (P = 0.019) and number of tracts (P = 0.024) showed a positive correlation with the mean hematocrit decrease.

Conclusions

Staghorn stones, multiple tracts, the presence of diabetes, and large stones were associated with increased renal hemorrhage during PCNL on multivariate analysis. However, balloon dilation was associated with decreased 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

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