Abstract

Introduction: Post-operative bleeding is a serious complication necessitating prompt attention in
Percutaneous Nephrolithotomy (PCNL). A number of factors dictate the severity of post-PCNL bleeding.
Identification of these risk factors helps prevent bleeding complications. Methods: In this observational
cross-sectional study, a total of 126 patients with renal stones >10mm or stag-horn stones underwent PCNL.
All the relevant pre- and intra-operative factors were noted and analyzed. Hemoglobin differences between
pre- and post-operative levels were considered for the evaluation of blood loss. Univariate and multivariable
logistic regression analysis was done. The strength of association was examined using Odds Ratio and
95% confidence intervals derived from the logistic regression. A p value <0.05 was considered statistically
significant. Results: The mean age of the patients was 31.9 ±4.47 years. The mean drop in hemoglobin
was 1.83 ±0.98 gm/dl. Age, stone size, number of tracts, size of Amplatz sheath and number of stones
significantly affected the blood loss in univariate analysis. Among the variables mentioned above only, the
number of stones could maintain the significance in multivariable analysis (p<0.05). The number of stones
increase the risk of bleeding post PCNL by 4.4 times. Conclusion: Stone size, number of tracts, size of
Amplatz sheath and the number of stones significantly affect the blood loss post PCNL. Identification of
these risk factors should be considered for minimizing bleeding in PCNL.

Keywords: Bleeding, Percutaneous nephrolithotomy, Risk factors