Factores clínicos relacionados a sangrado en la nefrolitotomia percutánea

Authors

  • Iván Calvo Vázquez MD
  • Baudelio Rodríguez-Rodríguez
  • Erick Alejandro Hernández-Méndez
  • Ulises Cristóbal Sánchez-Aquino Hospital General Dr. Manuel Gea González
  • Carlos Martínez-Arroyo Hospital General Dr. Manuel Gea González
  • Gerardo Fernández-Noyola Hospital General Dr. Manuel Gea González
  • Jorge Gustavo Morales-Montor Hospital General Dr. Manuel Gea González
  • Mauricio Cantellano-Orozco Hospital General Dr. Manuel Gea González
  • Carlos Pacheco-Gahbler Hospital General Dr. Manuel Gea González

DOI:

https://doi.org/10.48193/revistamexicanadeurologa.v79i1.385

Keywords:

Percutaneous nephrolithotomy, Hemoglobin, Hematocrit, bleeding

Abstract

Objective: To determine the factors associated with the decrease in hemoglobin and hematocrit in percutaneous nephrolithotomy.

Materials and methods:  Patients that underwent percutaneous nephrolithotomy within the time frame of January 2015 to January 2017 were included in the study. The factors associated with bleeding were analyzed using the Levene’s test, the Student’s t test, and inferential statistics.

Results: Sixty-nine patients underwent percutaneous nephrolithotomy. The mean decrease in hemoglobin and hematocrit after the procedure was 1.17 g/dl and 2.56%, respectively.  The statistically significant factors were: diabetes mellitus (Hb, p £ 0.001/Hct, p = 0.017), high blood pressure (p = 0.007/p = 0.050), stone morphology (p = 0.004/p = 0.003), stone area (p = 0.003/p = 0.003), number of tracts (p = 0.002/p = 0.012), and surgery duration (p £ 0.001/p = 0.010). Positive culture (p = 0.030) and stone size (p=0.028) were significant only in relation to the decrease in hematocrit. A total of 27.5% patients had undergone previous surgery, mean stone size was 3.26 cm, the lower calyx was the most frequently punctured (78.3%), mean tract length was 8.41cm, and mean surgery duration cutoff time was 140 min. In our study, diabetes mellitus (RR = 1.8, CI = 1.4-2.3), high blood pressure  (RR = 2.12, CI = 1.5-2.8), stone morphology (RR = 1.9, CI = 1.5-2.5), stone area (RR = 1.8, CI = 1.19-2.7), surgical technique and number of tracts  (RR = 1.7, CI = 1.4-2.1), and surgery duration (RR = 1.9, CI = 1.3 -2.8) were the risk factors associated with decreased Hb and Hct values in percutaneous nephrolithotomy.

Conclusions: Percutaneous nephrolithotomy is a minimally invasive procedure for the treatment of kidney stones. In our study, the incidence of bleeding was low, and the transfusion rate was minimal, at 2.9%. 

References

1. Türk C, Sarica K, Seitz C, Straub M. Guidelines on Urolithiasis. :38.
2. Fernström I, Johansson B. Percutaneous pyelolithotomy: a new extraction technique. Scand J Urol Nephrol. 1976;10(3):257-9.
3. Davidoff R, Bellman GC. Influence of technique of percutaneous tract creation on incidence of renal hemorrhage. J Urol. 1997;157(4):1229-31.
4. Michel MS, Trojan L, Rassweiler JJ. Complications in percutaneous nephrolithotomy. Eur Urol. 2007;51(4):899-906.
5. Fuchs GJ, Yurkanin JP. Endoscopic surgery for renal calculi. Curr Opin Urol. 2003;13(3):243-7.
6. Kessaris DN, Bellman GC, Pardalidis NP, Smith AG. Management of hemorrhage after percutaneous renal surgery. J Urol. 1995;153(3):604-8.
7. El-Assmy AM, Shokeir AA, Mohsen T, El-Tabey N, El-Nahas AR, Shoma AM, et al. Renal access by urologist or radiologist for percutaneous nephrolithotomy—is it still an issue? J Urol. 2007;178(3):916-20.
8. 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(2):327-33.
9. Kim SC, Kuo RL, Lingeman JE. Percutaneous nephrolithotomy: an update. Curr Opin Urol. 2003;13(3):235-41.
10. Aron M, Yadav R, Goel R, Kolla SB, Gautam G, Hemal AK, et al. Multi-tract percutaneous nephrolithotomy for large complete staghorn calculi. Urol Int. 2005;75(4):327-32.
11. Lewis S, Patel U. Major complications after percutaneous nephrostomy—lessons from a department audit. Clin Radiol. 2004;59(2):171-9.
12. Vorrakitpokatorn P, Permtongchuchai K, Raksamani E, Phettongkam A. Perioperative complications and risk factors of percutaneous nephrolithotomy. J-Med Assoc Thail. 2006;89(6):826.
13. Dogan HS, Şahin A, Çetinkaya Y, Akdogan B, Özden E, Kendi S. Antibiotic prophylaxis in percutaneous nephrolithotomy: prospective study in 81 patients. J Endourol. 2002;16(9):649-53.
14. Michel MS, Trojan L, Rassweiler JJ. Complications in percutaneous nephrolithotomy. Eur Urol. 2007;51(4):899-906.
15. Havel D, Saussine C, Fath C, Lang H, Faure F, Jacqmin D. Single stones of the lower pole of the kidney. Eur Urol. 1998;33(4):396-400.
16. 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(1):38-40.
17. Kukreja R, Desai M, Patel S, Bapat S, Desai M. First prize: factors affecting blood loss during percutaneous nephrolithotomy: Prospective Study. J Endourol. 2004;18(8):715-22.
18. Liatsikos EN, Kapoor R, Lee B, Jabbour M, Barbalias G, Smith AD. “Angular percutaneous renal access”. Multiple tracts through a single incision for staghorn calculous treatment in a single session. Eur Urol. 2005;48(5):832-7.
19. Turna B, Nazli O, Demiryoguran S, Mammadov R, Cal C. Percutaneous nephrolithotomy: variables that influence hemorrhage. Urology. 2007;69(4):603-7.

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Published

2019-04-04

Issue

Vol. 79 No. 1 (2019): Enero - Febrero

Section

Original articles