An assessment of the efficacy and safety of balloon nephrostomy traction in minimizing postoperative bleeding of percutaneous nephrolithotomy: a randomized controlled clinical trial

Abstract

Purpose: Percutaneous nephrolithotomy (PCNL) as an established procedure for treatment of large kidney stones, can trigger life threatening complications. Postoperative hemorrhaging is one of the main complications of PCNL. This study investigates the effectiveness of balloon nephrostomy in reducing hemorrhage in the postoperative phase of PCNL.

Methods and materials: A total of 102 patients underwent routine PCNL and then they were randomly allocated to intervention and control groups. For the intervention group, a balloon nephrostomy tube was inserted under guidance of fluoroscopy, gentle traction was applied on the nephrostomy and then it was fixed to skin under mild traction. A conventional nephrostomy tube was inserted in the control group without additional traction. Blood loss was estimated by hemoglobin drop in the first 24 h after surgery. Hemoglobin level drop was the primary endpoint of interest. Secondary endpoints were postoperative complications and were compared between treatment groups.

Results: The mean first 24-hour hemoglobin drop was 0.9 ± 0.2 mg/dL in the intervention group and 2.1 ± 0.2 mg/dL in the control group which was statistically significant (< 0.001). Although blood transfusion was more common in the control group (8% versus 0%), it was not statistically significant. There were no statistically significant differences between intervention and control groups regarding the postoperative complications.

Conclusion: In conclusion, the results of the present study show the effectiveness of the application of balloon nephrostomy in decreasing PCNL postoperative bleeding without considerable complication.

Trial registration no: IRCT20160406027253N2.

Keywords: Balloon nephrostomy; Percutaneous nephrolithotomy; Postoperative hemorrhage; Randomized clinical trial.