Predictive factors for percutaneous nephrolithotomy bleeding risks

Loo, U Phun; Yong, Chun Hou; Teh, Guan Chou

doi:10.1016/j.ajur.2022.02.003

Cited by 2 publications

(3 citation statements)

References 26 publications

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“…Tubeless PCNL has been found to be associated with shorter hospital stay, faster recovery, and lower total procedure cost, which may be preferred for patients who prioritize cost-effectiveness and faster recovery ( 9 ). However, post-PCNL transfusion rates ranged from 3–23% ( 10 ), and factors such as hypertension, puncture site, and operative duration are significantly associated with post-PCNL estimated hemoglobin difference ( 11 ). Therefore, it is often reserved for patients with non-complex stones, stones <3 cm, single-tract PCNL, and no residual stones ( 12 , 13 ).…”

Section: Discussionmentioning

confidence: 99%

Left endoscopic combined intrarenal surgery with electrocoagulation hemostasis and right flexible ureteroscopic lithotripsy for bilateral upper urinary tract stones: a case report

Xiong,

Kwan,

et al. 2024

Transl Androl Urol

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Background Percutaneous nephrolithotomy (PCNL) is the first-line treatment for large renal stones. However, multi-tract or staged procedures may be necessitated in bilateral or anatomically-complex stones to achieve stone clearance. Endoscopic combined intrarenal surgery (ECIRS) integrates the advantages of PCNL and retrograde intrarenal surgery. In this article, we detail a hybrid surgical technique adopted for the management of complex simultaneous bilateral upper urinary tract stones. In addition, we discuss the advantages and disadvantages of combining a variety of new techniques that may improve post-operative outcomes and patient satisfaction. Case Description We report the case of a 36-year-old male with a large left renal pelvis stone, right proximal ureteric stone, and bilateral renal stones. Biochemical results showed raised inflammatory markers but he denied pre-stenting and staged surgery. After receiving 3-day antibiotic prophylaxis, he underwent an elective hybrid procedure. Under split-leg prone position, we performed a hybrid procedure that included left ECIRS with tubeless single-tract mini PCNL and left flexible ureteroscopy, and right flexible ureteroscopic lithotripsy. Hemostasis was achieved by electrocauterization with a novel device. The patient made an uneventful recovery. Follow-up computed tomography (CT) at 1-month revealed complete stone clearance. Conclusions Unilateral ECIRS with tubeless single-tract mini PCNL with electrocoagulation hemostasis and adjacent retrograde intrarenal surgery in split-leg prone position is a safe, feasible, and efficient technique to manage large renal stones.

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Section: Discussionmentioning

confidence: 99%

Left endoscopic combined intrarenal surgery with electrocoagulation hemostasis and right flexible ureteroscopic lithotripsy for bilateral upper urinary tract stones: a case report

Xiong,

Kwan,

et al. 2024

Transl Androl Urol

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show abstract

“…In addition, measurement tools, bleeding estimation criteria, the accuracy of laboratories, and studied populations are not the same among studies. Also, the inclusion criteria of the studies as an influencing factor differ in terms of patients' characteristics, comorbidities, age, and preoperative status (12,17,18,21,27,29).…”

Section: Postoperative Large Hematomamentioning

confidence: 99%

“…The available studies' results are inconsistent, and there is no agreement on the issue (16). Some have demonstrated that hypertension, site of puncture, and duration of surgery significantly affect the reduction of Hb during PCNL, while operative position (supine/prone), the number of punctures, and tract dilatation size have no significant effect (17). In other studies, stone size, the number of tracts, the Copyright © 2022, Author(s).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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.

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Predictive factors for percutaneous nephrolithotomy bleeding risks

Cited by 2 publications

References 26 publications

Left endoscopic combined intrarenal surgery with electrocoagulation hemostasis and right flexible ureteroscopic lithotripsy for bilateral upper urinary tract stones: a case report

Left endoscopic combined intrarenal surgery with electrocoagulation hemostasis and right flexible ureteroscopic lithotripsy for bilateral upper urinary tract stones: a case report

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

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