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. 2022 Mar 28;56(1):70-76.
doi: 10.14744/SEMB.2021.21284. eCollection 2022.

Pre-Operative Parameters Predicting Hemoglobin Decline Related to Percutaneous Nephrolithotomy

Mithat Eksi  1 , Deniz Noyan Ozlu  2 , Taner Kargi  2 , Abdullah Hizir Yavuzsan  3 , Ahmet Haciislamoglu  2 , Serdar Karadag  2 , Selcuk Sahin  2 , Ali Ihsan Tasci  2
Affiliations

Pre-Operative Parameters Predicting Hemoglobin Decline Related to Percutaneous Nephrolithotomy

Mithat Eksi et al. Sisli Etfal Hastan Tip Bul. .

Abstract

Objectives: Percutaneous nephrolithotomy (PNL) for upper urinary tract stones is a minimally invasive, effective treatment modality. Despite its high success rates, its potential complications pose a risk. In this study, we aimed to determine the risk factors associated with bleeding which is one of PNL's most important complications.

Methods: The data of patients who underwent PNL between January 2017 and December 2018 were retrospectively analyzed. The median reduction in post-operative hemoglobin levels compared to preoperative levels was found to be 1.6 g/dl, which was accepted as the threshold value. The patients with hemoglobin decrease above the threshold were assigned as Group 1, and below the threshold as Group 2. Pre-operative, perioperative data, and stone characteristics of the patients were recorded.

Results: 169 patients, 85 patients in Group 1 and 84 patients in Group 2 were included in the study. The mean age of Group 1 was significantly higher (47.4±7.9 and 32±9.4 years, respectively, p=0.001) Sixteen in Group 1 (18.8%) and six in Group 2 (7, 1%) had a diagnosis of hypertension (HT) and a significant difference was found (p=0.038). The average stone burden was 2733±1121.3 mm3 in Group 1, and 2326.5±975.6 mm3 in Group 2. It was observed that there was a significantly higher stone burden in Group 1 (p=0.001). There was a significant difference between the groups in terms of mean operation time (84.4±7 and 76.2±9.9 min, respectively, p<0.001). When the complication rates were analyzed, complications were observed in 25 (29.4%) patients in Group 1 and 12 (14.2%) patients in Group 2, and a significant difference was found between both groups (p=0.019). Age and HT were found to be significant independent risk factors associated with hemoglobin decline in multivariate analyzes (p<0.001 and p<0.027, respectively).

Conclusion: In this study; advanced age, presence of HT, and high stone burden were found to be predictive of reductions in hemoglobin levels. Furthermore, a correlation of decreased hemoglobin levels was detected with operative times and occurrence of complications.

Keywords: Hemorrhage; kidney calculi; percutaneous nephrolithotomy.

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Figures

Figure 1.
Figure 1.
Receiver operating characteristic curve analysis of predictors of hemoglobin decrease.
See this image and copyright information in PMC

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