Korean J Urol.  2013 Jul;54(7):448-453.

Predictive Factors for Bleeding During Percutaneous Nephrolithotomy

• Lee JK
• Kim BS
• Park YK

Abstract

PURPOSE
Although percutaneous nephrolithotomy (PCNL) has been accepted as a standard method for the management of large renal stones, the incidence of renal hemorrhage is relatively high. This study investigated the variables that affect bleeding during PCNL.
MATERIALS AND METHODS
The medical records of 370 patients who underwent PCNL by a single surgeon from January 2005 to December 2010 were reviewed retrospectively. All patients were divided into two groups according to median blood loss (lesser bleeding group and higher bleeding group). Various clinical and perioperative factors including age, sex, stone size and position, degree of hydronephrosis, operative time, underlying disease, history of anticoagulant medication, presence of previous nephrostomy catheter, stone composition, and thickness of the renal cortex were assessed. For statistical assessment, univariate and multivariate logistic regression analyses were used.
RESULTS
The mean patient age was 48.8 years (range, 22 to 75 years). Forty-three patients (11.6%) received a transfusion and 9 patients (2.4%) underwent angioembolization after surgery. The mean blood loss was 511.8+/-341.3 mL. Body mass index (BMI), stone size, stone position, operation time, and degree of preoperative hydronephrosis were predictive factors for severe bleeding during PCNL.
CONCLUSIONS
On the basis of the results achieved by a single surgeon, staghorn stones, high BMI, large stones, prolonged operation time, and absence of hydronephrosis were significantly associated with the risk of severe bleeding during PCNL.

Keyword

Hemorrhage; Kidney calculi; Percutaneous nephrolithotomy

MeSH Terms

Body Mass Index
Catheters
Hemorrhage
Humans
Hydronephrosis
Incidence
Kidney Calculi
Logistic Models
Medical Records
Nephrostomy, Percutaneous
Operative Time
Retrospective Studies

Reference

1. Rupel E, Brown R. Nephroscopy with removal of stone following nephrostomy for obstructive calculous anuria. J Urol. 1941. 46:177–182.

2. Fernstrom I, Johansson B. Percutaneous pyelolithotomy: a new extraction technique. Scand J Urol Nephrol. 1976. 10:257–259.

3. Alken P, Hutschenreiter G, Gunther R, Marberger M. Percutaneous stone manipulation. J Urol. 1981. 125:463–466.

4. Al-Kohlany KM, Shokeir AA, Mosbah A, Mohsen T, Shoma AM, Eraky I, et al. Treatment of complete staghorn stones: a prospective randomized comparison of open surgery versus percutaneous nephrolithotomy. J Urol. 2005. 173:469–473.

5. Preminger GM, Assimos DG, Lingeman JE, Nakada SY, Pearle MS, Wolf JS Jr, et al. Chapter 1: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol. 2005. 173:1991–2000.

6. Labate G, Modi P, Timoney A, Cormio L, Zhang X, Louie M, et al. The percutaneous nephrolithotomy global study: classification of complications. J Endourol. 2011. 25:1275–1280.

7. Lee WJ, Smith AD, Cubelli V, Badlani GH, Lewin B, Vernace F, et al. Complications of percutaneous nephrolithotomy. AJR Am J Roentgenol. 1987. 148:177–180.

8. Stoller ML, Wolf JS Jr, St Lezin MA. Estimated blood loss and transfusion rates associated with percutaneous nephrolithotomy. J Urol. 1994. 152(6 Pt 1):1977–1981.

9. Turna B, Nazli O, Demiryoguran S, Mammadov R, Cal C. Percutaneous nephrolithotomy: variables that influence hemorrhage. Urology. 2007. 69:603–607.

10. Segura JW, Patterson DE, LeRoy AJ, Williams HJ Jr, Barrett DM, Benson RC Jr, et al. Percutaneous removal of kidney stones: review of 1,000 cases. J Urol. 1985. 134:1077–1081.

11. Liatsikos EN, Kallidonis P, Stolzenburg JU, Ost M, Keeley F, Traxer O, et al. Percutaneous management of staghorn calculi in horseshoe kidneys: a multi-institutional experience. J Endourol. 2010. 24:531–536.

12. Kessaris DN, Bellman GC, Pardalidis NP, Smith AG. Management of hemorrhage after percutaneous renal surgery. J Urol. 1995. 153(3 Pt 1):604–608.

13. Akman T, Binbay M, Sari E, Yuruk E, Tepeler A, Akcay M, et al. Factors affecting bleeding during percutaneous nephrolithotomy: single surgeon experience. J Endourol. 2011. 25:327–333.

14. McCullough TC, Roth JV, Ginsberg PC, Harkaway RC. Estimated blood loss underestimates calculated blood loss during radical retropubic prostatectomy. Urol Int. 2004. 72:13–16.

15. Whitfield HN, Mills VA. Percutaneous nephrolithotomy: a report of 150 cases. Br J Urol. 1985. 57:603–604.

16. Wong MY. An update on percutaneous nephrolithotomy in the management of urinary calculi. Curr Opin Urol. 2001. 11:367–372.

17. Lingeman JE, Coury TA, Newman DM, Kahnoski RJ, Mertz JH, Mosbaugh PG, et al. Comparison of results and morbidity of percutaneous nephrostolithotomy and extracorporeal shock wave lithotripsy. J Urol. 1987. 138:485–490.

18. White EC, Smith AD. Percutaneous stone extraction from 200 patients. J Urol. 1984. 132:437–438.

19. el-Kenawy MR, el-Kappany HA, el-Diasty TA, Ghoneim MA. Percutaneous nephrolithotripsy for renal stones in over 1000 patients. Br J Urol. 1992. 69:470–475.

20. Sacha K, Szewczyk W, Bar K. Massive haemorrhage presenting as a complication after percutaneous nephrolithotomy (PCNL). Int Urol Nephrol. 1996. 28:315–318.

21. Patterson DE, Segura JW, LeRoy AJ, Benson RC Jr, May G. The etiology and treatment of delayed bleeding following percutaneous lithotripsy. J Urol. 1985. 133:447–451.

22. Martin X, Murat FJ, Feitosa LC, Rouviere O, Lyonnet D, Gelet A, et al. Severe bleeding after nephrolithotomy: results of hyperselective embolization. Eur Urol. 2000. 37:136–139.

23. Srivastava A, Singh KJ, Suri A, Dubey D, Kumar A, Kapoor R, et al. Vascular complications after percutaneous nephrolithotomy: are there any predictive factors? Urology. 2005. 66:38–40.

24. Davidoff R, Bellman GC. Influence of technique of percutaneous tract creation on incidence of renal hemorrhage. J Urol. 1997. 157:1229–1231.

25. Heggagi MA, Karsza A, Szule E Jr. Use of different types of dilator systems in the prevention of complications of percutaneous (PC) renal surgery. Acta Chir Hung. 1991. 32:365–369.

26. Safak M, Gogus C, Soygur T. Nephrostomy tract dilation using a balloon dilator in percutaneous renal surgery: experience with 95 cases and comparison with the fascial dilator system. Urol Int. 2003. 71:382–384.

27. Tefekli A, Ali Karadag M, Tepeler K, Sari E, Berberoglu Y, Baykal M, et al. Classification of percutaneous nephrolithotomy complications using the modified clavien grading system: looking for a standard. Eur Urol. 2008. 53:184–190.

28. Gavant ML, Gold RE, Church JC. Delayed rupture of renal pseudoaneurysm: complication of percutaneous nephrostomy. AJR Am J Roentgenol. 1982. 138:948–949.

29. El-Nahas AR, Shokeir AA, El-Assmy AM, Mohsen T, Shoma AM, Eraky I, et al. Post-percutaneous nephrolithotomy extensive hemorrhage: a study of risk factors. J Urol. 2007. 177:576–579.

30. Gremmo E, Ballanger P, Dore B, Aubert J. Hemorrhagic complications during percutaneous nephrolithotomy. Retrospective studies of 772 cases. Prog Urol. 1999. 9:460–463.