Percutaneous nephrolithotomy; alarming variables for postoperative bleeding

Abstract

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.

Predictors for severe hemorrhage requiring angioembolization post percutaneous nephrolithotomy: A single-center experience over 3 years

“…Transfusion rates after PCNL reported in the literature range from 3% to 23%. [478910111213] The 3.08% transfusion rate of our study is comparable to this.…”

“…While it was also recognized as a significant factor for post-PCNL bleeding by Said et al . and Yesil et al .,[1015] the reverse was stated by Kukreja et al . [16] Gupta et al .…”

The Evaluation of Hemoglobin Fluctuation After Percutaneous Nephrolithotomy

“…In 32 cases (10%) blood transfusion was required, in 12 cases (3,75%) surgical haemostasis was performed, and there were no deaths after PCNL. In cases of severe bleeding, without the possibility of performing haemostasis, angiography and arterial embolization may be required (0.3 to 1.4% of the cases) [18,22]. The severity of the bleeding depends also on the comorbidities of the patients [23-26] and the current therapeutic scheme [27][28].…”

Previous Open Stone Surgery: Is It a Risk Factor for Bleeding in Percutaneous Nephrolithotomy

“…In their study comparing 65 patients with previous nephrolithotomy and 117 patients without any history of renal surgery, Basiri et al (7) observed no difference in terms of complications including bleeding. Said et al (8), however, stated that previous open surgery can be an important determinant for hemorrhage and transfusion requirement in PNL. Yesil et al (9) reported that severe hemorrhages requiring angioembolization were frequent in their 42 patients who underwent open renal surgery.…”