Risk Factors for Intra-operative Bleeding in Percutaneous Nephrolithotomy in an Academic Center: A Retrospective Study

Hamidreza Nasseh; Gholamreza Mokhtari; Samira Ghasemi; Gelareh Biazar; Ehsan Kazemnezhad Leyli; Keivan Gholamjani Moghaddam

doi:10.5812/aapm-126974

Risk Factors for Intra-operative Bleeding in Percutaneous Nephrolithotomy in an Academic Center: A Retrospective Study

Anesth Pain Med. 2022 Aug 28;12(4):e126974. doi: 10.5812/aapm-126974. eCollection 2022 Aug.

Authors

Hamidreza Nasseh¹, Gholamreza Mokhtari¹, Samira Ghasemi², Gelareh Biazar³, Ehsan Kazemnezhad Leyli⁴, Keivan Gholamjani Moghaddam¹

Affiliations

¹ Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
² Shahid Beheshti University of Medical Sciences, Tehran, Iran.
³ Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran.
⁴ Guilan Road Trauma Research Center, Biostatistics Department, Guilan University of Medical Sciences, Rasht, Iran.

Abstract

Background: Percutaneous nephrolithotomy (PNL) is the treatment of choice for renal stones as a safe, effective, and minimally invasive method. However, bleeding remains a major concern in the procedure.

Objectives: This study aimed to investigate the risk factors of bleeding in PNL.

Methods: This retrospective descriptive cross-sectional study was conducted in the Urology department of Razi hospital. The data of patients with urinary calculi staghorn type who underwent PNL in a prone position under general anesthesia were recorded. A checklist including patients' demographics, surgical characteristics, and outcomes was filled out for each patient.

Results: The data from 151 complete files were gathered. The mean age of the cases was 47.89 ± 12.41 years. The mean hemoglobin (Hb) drop was 1.92 ± 1.56 mg/dL. At least 1 mg/dL Hb drop was observed in all cases. The highest Hb drop was 3 mg/dL.). There was no significant relationship between stone bulk, age, BMI, GFR, surgery duration, and the number of tracts, and Hb drop during PNL (P > 0.05). But there was a positive correlation between Urinary Tract Infection (UTI) history (P = 0.01) and transfusion (P = 0.0001) and Hb drop during PNL. Also, the history of open kidney surgery (P = 0.031), nephrostomy insertion (P = 0.003), and extracorporeal shock wave lithotripsy therapy (ESWL) (P = 0.041) were correlated with the increased risk of Hb drop.

Conclusions: Urinary tract infection, history of open surgery, nephrostomy implantation, and ESWL were significantly associated with more bleeding in PNL.

Keywords: Bleeding; Intraoperative Complications; Percutaneous Nephrolithotomy; Risk Factors.