ObjectivesTo evaluate factors contributing to bleeding after percutaneous nephrolithotomy (PCNL) and ways of managing this complication, as bleeding is a serious sequela that requires prompt management.Patients and methodsThe demographic and procedural data of 200 patients, who underwent unilateral PCNL during a 20-month period, were prospectively collected. Preoperative, operative, and postoperative details were recorded. The preoperative variables analysed included: age, sex, body mass index (BMI), the presence of hypertension, diabetes mellitus, serum creatinine, degree of hydronephrosis, previous ipsilateral open renal surgery, stone size and complexity. The operative variables analysed included: number of tracts, operative time, size of Amplatz sheath, type of anaesthesia, and complications such as calyceal and pelvic perforation.ResultsThe variables of age, sex, BMI, diabetes, hypertension, and a preoperative creatinine level of >1.4 mg/dL had no significant effect on blood loss (all P > 0.05). However, the rate of bleeding was significantly higher (P ⩽ 0.05) in patients who had a history of previous open renal surgery, intraoperative pelvicalyceal perforations, and Guy’s Stone Score (GSS) grade 3 and 4 complex stones; however, absence of hydronephrosis, larger stone size, operative time (>83 min), more than one puncture, and size of the Amplatz sheath (26–30 F) did not maintain their significance in multivariate analysis.ConclusionAccording to our present results stone complexity (GSS grade 3 and 4), history of ipsilateral renal stone surgery, and occurrence of intraoperative pelvicalyceal perforation are alarming variables for post-PCNL bleeding.

No abstract

Purpose: To assess the effect of extracorporeal shockwave lithotripsy (SWL) on blood pressure, patients' tolerance to pain and perirenal hematoma in patients with renal stones. Patients and methods: One hundred eighty nine patients between 2007-2009 underwent SWL procedures at 4.5 and 5.5 KV with shockwaves of up to 4,000 and 5,000 shockwaves, they were followed up for post procedure pain, hypertension and perirenal hematoma. For statistical analysis, chi square test was used. Results: One hundred fifty three (81%) patients developed post procedure pain. The degree of pain was of mild that relieved by analgesia to severe that required hospitalization, increasing energy level did not increase the chance of post SWL pain while the larger stones caused more post SWL pain (p = .003). Fifteen patients (7.9%) developed post SWL hypertension, female patients and age more than 50 years found to increase the risk of post SWL hypertension. Post SWL hypertension is not affected by increasing energy level and number of shockwaves. Only one patient (0.52%) developed post SWL perirenal hematoma. Conclusion: SWL has a high incidence of post SWL pain. Females and age above 50 years are more prone to develop post SWL hypertension. However the number of shockwaves and energy level did not increase the risk of developing post SWL hypertension. Perirenal hematoma is a rare complication of SWL.