ABSTRACT
Objective: To evaluate the factors that may increase bleeding during Percutaneous nephrolithotomy [PCNL] and correlate them with outcome
Study Design: Analytical study
Place and Duration of Study: The Kidney Centre postgraduate Training Institute, Karachi, Pakistan, from July to December 2016
Methodology: Consecutive patients who underwent PCNL from July to December 2016 were prospectively enrolled. Drop in hemoglobin was divided into three groups: mild <1 gm/dl, moderate 1-2 gm/dl and major > 2 gm/dl. Factors such as age, gender, comorbidities, body mass index [BMI], operative time, creatinine levels, renal cortical thickness, stone size, its characteristics and location, puncture type and site, and need for blood transfusion were assessed by Chi-square/ Fisher exact test and Kruskal Wallis test. Predictive factors were assessed by multinomial logistic-regression analyses
Results: Total 305 patients were enrolled in the study. Median age was 37 [27.5-49.1] years with predominantly males [n=217, 71.8%]. Median BMI was 27.3 [24.6-31.4] Kg/m[2] and mean stone size was 2.7 [2.1-3.4] cm. Two hundred and ninety-seven [97.7%] stones were radio-opaque. Operative time was 95 [60-127] minutes. There were 50.8% patients who had moderate drop in hemoglobin [1-2 gm/dl]. Stone size, BMI and operative time were strongly associated with significant drop in hemoglobin. Complete stone clearance was achieved in 256 [84%] patients. Thirty [9.8%] patients needed blood transfusion. None of the patients required angioembolisation
Conclusion: BMI, stone size, and operative time were strongly associated with intraoperative blood loss during PCNL