Blood loss predictive factors and transfusion practice during percutaneous nephrolithotomy of kidney stones: a prospective study

Syahputra, Firtantyo Adi; Birowo, Ponco; Rasyid, Nur; Matondang, Faisal Abdi; Noviandrini, Endrika; Harjanggi, Maruto

doi:10.12688/f1000research.8993.1

Cited by 17 publications

(15 citation statements)

References 24 publications

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“…Firtantyo Adi Syahputra et al 2016 showed a mean hematocrit drop 5.20 % in PCNL. 8 No robust study comparing mean hematocrit drop depending on the energy sources are available till now. In our study major complications requiring treatment were bleeding, hydrothorax, urinary extravasation, and urinary leakage.…”

Section: Resultsmentioning

confidence: 99%

A Comparative Study Between Holmium Laser, Pneumatic Lithotripsy and Shock Pulse in Terms of Efficacy and Safety in Percutaneous Nephrolithotomy (PCNL): A Prospective Randomized Study

Rajeev

Pratihar

Sarma

et al. 2020

Journal of Endoluminal Endourology

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Background and ObjectivesPercutaneous nephrolithotomy (PCNL) occupies an essential place in the treatment of upper urinary tract calculi. PCNL also accomplishes higher stone-free rates and requires fewer auxiliary procedures than shock wave lithotripsy (SWL) and ureterorenoscopy (URS) for renal stones between 1–2 cm. There are different intracorporeal lithotripter devices available. This study aims to compare the efficacy and safety of holmium laser, pneumatic lithotripsy and Shock Pulse in PCNL. Materials and MethodsA prospective randomized study was performed in Gauhati Medical College & Hospital, Guwahati, Assam, India, between October 2016 to November 2018. Patients of renal calculi and upper ureteric calculi less than or equal to 2.5cms and functioning kidney on the ipsilateral side were included. 300 patients were randomized according to a random number generator. In the holmium laser, pneumatic and Shock Pulse groups’ number of patients was 96, 102, 102 respectively. Stone disintegration time (SDT), stone-free rate, failure rate, success rate, irrigant used, mean hematocrit drop were evaluated. Statistical analysis was done to compare and predict any significant difference. ResultsPatients were divided into groups depending on the lithotripter used: group A (n=96), group B (n=102), group C (n=102) were holmium laser, pneumatic lithotripsy, and Shock Pulse respectively. No significant difference in stone location (p=0.785),Hounsfield unit (p=0.115),complication rates between the groups. Stone free rate in laser, pneumatic lithotripter, and Shock Pulse were 81.25%, 67.65%, 82.35% (highest in Shock Pulse and lowest in the Pneumatic group) and failure rate were 6.25%, 14.7%, 5.89% respectively. A significant difference was found in terms of stone-free, success rate, clinically insignificant residual fragments(CIRF)and failure rates between the groups(p<0.001). Irrigant requirement (litre/mm3) between the groups is statistically significant (p<0.001) with the highest in Shock Pulse and lowest in the Pneumatic group. Mean hematocrit drop: 4.19%, 4.20%, 5.46% in Laser, Pneumatic and Shock Pulse respectively. No significant difference between Laser and Pneumatic group (p=0.907), but in Shock Pulse group it is significantly higher. (p< 0.001) ConclusionEfficacy of energy sources used in PCNL for stone fragmentation vary in terms of stone clearance, failure rates, SDT, irrigant requirement and mean hematocrit drop. In our study, we found stone clearance signifi-cantly higher in Shock Pulse than Pneumatic and Laser groups. Stone fragmentation volume per unit time highest in Shock Pulse and lowest in Laser. Irrigant requirement highest in Shock Pulse group and compa-rable between Laser and Pneumatic group. The higher irrigant requirement in the Shock Pulse group may be the cause for higher hematocrit drop in this group. Complications between the groups are comparable.

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Section: Resultsmentioning

confidence: 99%

A Comparative Study Between Holmium Laser, Pneumatic Lithotripsy and Shock Pulse in Terms of Efficacy and Safety in Percutaneous Nephrolithotomy (PCNL): A Prospective Randomized Study

Rajeev

Pratihar

Sarma

et al. 2020

Journal of Endoluminal Endourology

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“…Consequently, children listed for primary PCNL often have a large and complex stone burden. That may be the reason that the transfusion rate in pediatric series (14-24%) is higher than in adults (7-8%) [29]. Given the smallness and fragility of the pediatric kidneys, and the clearly established association between scope/tract diameter and bleeding [25], mini-PCNL seems the way to go in children.…”

Section: Discussionmentioning

confidence: 99%

Mini-Percutaneous Nephrolithotomy for Complex Staghorn Stones in Children

Rashid¹,

Amin²,

Kadum³

et al. 2019

Urol Int

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Objectives: To evaluate the safety and efficacy of percutaneous mini-nephrolithotomy (mini-PCNL) in children with complex staghorn stones. Patients and Methods: We analyzed prospectively data of 28 children undergoing pediatric mini-PCNL during a period of 18 months. Stone complexity was defined according to the validated Guy’s stone score (GSS). Our patients were GSS III and IV. All PCNL procedures were performed in the prone position, under fluoroscopic guidance, and in the same standardized fashion with F12 and F17 mini-nephroscopes. Results: Eleven children were boys (total n = 28). Mean age was 7.25 ± 3.27 (2–14) years. Mean stone burden was 36.89 ± 8.002 (30–60) mm. GSS was in 57% grade III and in 43% grade IV. The initial stone-free rate was 78%, which increased to 89% after few ancillary procedures. Seventeen percent of children had major complications (1 hydrothorax, 4 blood transfusions). On statistical analysis, stone clearance rates were found inversely dependent on stone complexity (GSS; p < 0.025). Stone burden, number of tracts, and procedure time were associated with stone complexity (p < 0.000). In turn, stone complexity (p < 0.015) and the number of tracts (p < 0.049) were significantly associated with complications. Conclusion: Mini-PCNL is effective and safe for treating complex renal stones in pediatric patients. Complication rates are acceptable and predictably stable on comparison with the literature.

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“…Access to the renal pelvis through the posterior calyx is known to be the best route [2]. Access should be made as such to avoid vascular injuries, such as injuries to segmental and interlobar arteries [3]. Bleeding is a common complication of PNL.…”

Section: Introductionmentioning

confidence: 99%

Frequency of Blood Transfusion in Percutaneous Nephrolithotomy

Ullah¹,

Ali

Karimi

et al. 2020

Cureus

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Introduction Percutaneous nephrolithotomy (PNL) has replaced open surgery for the treatment of kidney stones due to its less invasive nature. Bleeding still occurs due to renal vascular injuries, dependent upon the access route of the procedure. Several other factors are also related to the increased risk of bleeding. This study aims to find the association between blood transfusion and other factors such as age, gender, body mass index (BMI), size of the stone, operative time, preoperative hemoglobin (Hb) level, stone surface area, hypertension, and diabetes mellitus. Materials and methods This was a descriptive cross-sectional study conducted over a period of six months between November 2019 and April 2020 at a tertiary care hospital in Karachi, Pakistan. The sample size of 131 patients was calculated using open-source epidemiological software (Open-Epi). Inclusion criteria included patients from both genders and ages between 26 and 70 years. Patients ≤25 years, having a liver disease or bleeding disorders, or refusing to participate in the study, were excluded. Laboratory data included preoperative routine complete blood count, serum creatinine (normal 0.5-1.5 mg/dL), platelet count, bleeding and coagulation profile, and urine culture. All patients also underwent renal ultrasound scans. Treatment was postponed until a negative urine culture was obtained from patients with a positive urine culture. Results The mean age of the patients was 42.4 ± 15.65 years. One third (29.8%) of the patients were females. The stone size was 850 ± 121.43 mm², the mean operative time of the procedure was 125.76 ± 53.4 minutes, and the mean number of cell packs transfused was 1.10 ± 0.31 units. Blood transfusion was done in 24 (18.3%) of the patients. Gender, diabetes mellitus, stone size, preoperative Hb level, and operative time were significantly related to blood transfusion. Conclusions Increased bleeding risk while performing PNL has been associated with many factors such as operating time, the gender of the patients, and stone size. Therefore, these factors should be controlled for the procedure to decrease the risk of bleeding and the need for blood transfusion. Furthermore, the kidney vasculature should not be compromised while performing the procedure.

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Blood loss predictive factors and transfusion practice during percutaneous nephrolithotomy of kidney stones: a prospective study

Cited by 17 publications

References 24 publications

A Comparative Study Between Holmium Laser, Pneumatic Lithotripsy and Shock Pulse in Terms of Efficacy and Safety in Percutaneous Nephrolithotomy (PCNL): A Prospective Randomized Study

A Comparative Study Between Holmium Laser, Pneumatic Lithotripsy and Shock Pulse in Terms of Efficacy and Safety in Percutaneous Nephrolithotomy (PCNL): A Prospective Randomized Study

Mini-Percutaneous Nephrolithotomy for Complex Staghorn Stones in Children

Frequency of Blood Transfusion in Percutaneous Nephrolithotomy

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