Predictive Factors for Post-Operative Bleeding in Percutaneous Nephrolithotomy.
DOI:
https://doi.org/10.22502/jlmc.v7i2.283Keywords:
Bleeding, Percutaneous nephrolithotomy, Risk factorsAbstract
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.
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References
Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP et al. Surgical Management of Stones: American Urological Association/Endourological Society Guideline, PART I. The Journal of Urology. 2016;196(4):1161-69. DOI: https:// doi.org/10.1016/j.juro.2016.05.091
Jessen JP, Honeck P, Knoll T, Wendt-Nordahl G. Percutaneous nephrolithotomy under combined sonographic/radiologic guided puncture: results of a learning curve using the modified Clavien grading system. World Journal of Urology. 2013;31(6):1599–603. DOI: https://doi.org/10.1007/s00345-012- 1016-9
Said SHA, Hassan MAA, Ali RHG, Aghaways I, Kakamad FH, Mohammad KQ. Percutaneous nephrolithotomy; alarming variables for postoperative bleeding. Arab Journal of Urology. 2017;15(1):24-29. DOI: https://doi.org/10.1016/j.aju.2016.12.001
Keoghane SR, Cetti RJ, Rogers AE and Walmsley BH. Blood transfusion, embolization and nephrectomy after percutaneous nephrolithotomy (PCNL). British Journal of Urology International. 2013;111(4):628-32. DOI: https://doi. org/10.1111/j.1464-410X.2012.11394
Syahputra FA, Birowo P, Rasyid N, Matondang FA, Noviandrini E, Huseini MH. Blood loss predictive factors and transfusion practice during percutaneous nephrolithotomy of kidney stones: a prospective study. F1000Research. 2016;5:1550. DOI: https:// doi.org/10.12688/f1000research.8993.1
Lee JK, Kim BS and Park YK. Predictive factors for bleeding during percutaneous nephrolithotomy. Korean Journal of Urology. 2013;54(7):448–53. PMID: 23878687. DOI: https://doi.org/10.4111/kju.2013.54.7.448
Gök A, Güneş ZE, Kılıç S, Gök B, Yazıcıoglu AY. Factors influencing the duration of fluoroscopy in percutaneous nephrolithotomy. Journal of Clinical and Analytical Medicine. 2014;5(4):300-3. DOI: https://doi.org/ 10.4328/JCAM.1318 Available from: https://bit.ly/2qnDw3p
Mousavi-Bahar SH, Mehrabi S, Moslemi MK. Percutaneous nephrolithotomy complications in 671 consecutive patients: a single-center experience. Urol J. 2011;8(4):271–6. PMID: 22090044
Kumar NA, Chaitanya SV, Bezawada S, Gouri SRS. Post percutaneous nephrolithotomy massive hematuria: our experience. International Journal of Contemporary Medical Research 2016;3(5):1499-1502. Available from: https://www.ijcmr.com/ volume-3-issue-5.html
Yesil S, Ozturk U, Goktug HN, Tuygun C, Nalbant I, Imamoglu MA. Previous open renal surgery increased vascular complications in percutaneous nephrolithotomy (PCNL) compared with primary and secondary PCNL and extracorporeal shock wave lithotripsy patients: a retrospective study. Urol Int. 2013;91(3):331-4. PMID: 23867857 DOI: https://doi.org/10.1159/000351968
Kukreja R, Desai M, Patel S, Bapat S, Desai M. First Prize: Factors affecting blood loss during percutaneous nephrolithotomy: a prospective study. Journal of Endourology. 2004;18(8):715-22. DOI: https://doi. org/10.1089/end.2004.18.715
Gok A, Cift A. Predictive factors for bleeding that require a blood transfusion after percutaneous nephrolithotomy. Int J Clin Exp Med. 2017;10(9):13772-13777. Available from: http://ijcem.com/files/ijcem0058694. pdf
Stoller ML, Wolf JS, St. Lezin MA. Estimated blood loss and transfusion rates associated with percutaneous nephrolithotomy. The Journal of Urology. 1994;152(6 Part 1):1977-81. DOI: https://doi.org/10.1016/ S0022-5347(17)32283-8
Basnet RB, Shrestha A, Shrestha PM, Joshi BR. Risk Factors for Postoperative Complications after Percutaneous Nephrolithotomy. J Nepal Health Res Counc. 2018;16(1):79-83. PMID: 29717295 DOI: https://doi.org/10.3126/jnhrc. v16i1.19371
Tan J, Chen B, He L, Yin G, Jiang Z, Yao K et al. Renal access through the inferior ca¬lyx is associated with a higher risk of severe bleeding after percutaneous nephrolithoto¬my. Arch Med Sci. 2015;11(2):340-5. PMID: 25995750. DOI: https://doi.org/10.5114/ aoms.2015.50966

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