Purpose: There is conflict of evidence regarding whether absence of hydronephrosis is a risk factor for bleeding in percutaneous nephrolithotomy (PNL). Moreover, among the stone complexity scoring system used for PNL (Guy’s stone score, the S.T.O.N.E. nephrometry and the CROES nomogram), only the S.T.O.N.E. nephrometry score incorporates hydronephrosis as a risk factor. Therefore, this study aimed to compare perioperative outcomes according to the presence or absence of hydronephrosis in percutaneous nephrolithotomy (PCNL) patients and to investigate whether absence of hydronephrosis is a risk factor for blood transfusion rate.
Materials and Methods: 281 patients who had undergone PCNL between December 2009 and April 2017 were divided according to the absence or presence of hydronephrosis (group I and group II, respectively). Perioperative outcomes were compared between the two groups. A multivariable regression analysis was performed to investigate whether hydronephrosis was a risk factor for blood transfusion rate.
Results: Patients without hydronephrosis showed significantly longer operation time and admission period, lower stone-free rate and higher blood transfusion rate compared to patients with hydronephrosis (p < 0.05, p = 0.002, p = 0.011, and p < 0.05, respectively). Multivariate logistic regression analysis showed that hydronephrosis was a significant risk factor for blood transfusion (OR, 95% CI and p value was 0.353, 0.163-0.761 and 0.008, respectively).
Conclusion: Based on the results of the current study, we found that absence of hydronephrosis was a significant risk factor for blood transfusion in conventional PCNL.
Turk C, Petrik A, Sarica K, et al. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol. 2016;69:475-82.
Ghani KR, Andonian S, Bultitude M, et al. Percutaneous Nephrolithotomy: Update, Trends, and Future Directions. Eur Urol. 2016;70:382-96.
Angulo JC, Bernardo N, Zampolli H, Rivero MA, Davila H, Gutierrez J. Trends in the management of urolithiasis in Latin America, Spain and Portugal: results of a survey in the Confederacion Americana de Urologia (CAU). Actas Urol Esp. 2017.
Zanetti SP, Boeri L, Catellani M, et al. Retrograde intrarenal surgery (RIRS), regular and small sized percutaneous nephrolithotomy (PCNL) in daily practice: European Association of Urology Section of Urolithiasis (EULIS) Survey. Arch Ital Urol Androl. 2016;88:212-6.
Labate G, Modi P, Timoney A, et al. The percutaneous nephrolithotomy global study: classification of complications. J Endourol. 2011;25:1275-80.
Seitz C, Desai M, Hacker A, et al. Incidence, prevention, and management of complications following percutaneous nephrolitholapaxy. Eur Urol. 2012;61:146-58.
Akman T, Binbay M, Sari E, et al. Factors affecting bleeding during percutaneous nephrolithotomy: single surgeon experience. J Endourol. 2011;25:327-33.
Keoghane SR, Cetti RJ, Rogers AE, Walmsley BH. Blood transfusion, embolisation and nephrectomy after percutaneous nephrolithotomy (PCNL). BJU Int. 2013;111:628-32.
Kukreja R, Desai M, Patel S, Bapat S, Desai M. Factors affecting blood loss during percutaneous nephrolithotomy: prospective study. J Endourol. 2004;18:715-22.
Lee JK, Kim BS, Park YK. Predictive factors for bleeding during percutaneous nephrolithotomy. Korean J Urol. 2013;54:448-53.
Senocak C, Ozbek R, Bozkurt OF, Unsal A. Predictive factors of bleeding among pediatric patients undergoing percutaneous nephrolithotomy. Urolithiasis. 2017.
Thomas K, Smith NC, Hegarty N, Glass JM. The Guy's stone score--grading the complexity of percutaneous nephrolithotomy procedures. Urology. 2011;78:277-81.
Okhunov Z, Friedlander JI, George AK, et al. S.T.O.N.E. nephrolithometry: novel surgical classification system for kidney calculi. Urology. 2013;81:1154-9.
Smith A, Averch TD, Shahrour K, et al. A nephrolithometric nomogram to predict treatment success of percutaneous nephrolithotomy. J Urol. 2013;190:149-56.
Tiselius HG, Andersson A. Stone burden in an average Swedish population of stone formers requiring active stone removal: how can the stone size be estimated in the clinical routine? Eur Urol. 2003;43:275-81.
Muslumanoglu AY, Tefekli A, Karadag MA, Tok A, Sari E, Berberoglu Y. Impact of percutaneous access point number and location on complication and success rates in percutaneous nephrolithotomy. Urol Int. 2006;77:340-6.
Mandal S, Goel A, Kathpalia R, et al. Prospective evaluation of complications using the modified Clavien grading system, and of success rates of percutaneous nephrolithotomy using Guy's Stone Score: A single-center experience. Indian J Urol. 2012;28:392-8.
Wu WJ, Okeke Z. Current clinical scoring systems of percutaneous nephrolithotomy outcomes. Nat Rev Urol. 2017;14:459-69.
Sampaio FJ, Zanier JF, Aragao AH, Favorito LA. Intrarenal access: 3-dimensional anatomical study. J Urol. 1992;148:1769-73.
El-Nahas AR, Shokeir AA, El-Assmy AM, et al. Post-percutaneous nephrolithotomy extensive hemorrhage: a study of risk factors. J Urol. 2007;177:576-9.
Liu Q, Zhou L, Cai X, Jin T, Wang K. Fluoroscopy versus ultrasound for image guidance during percutaneous nephrolithotomy: a systematic review and meta-analysis. Urolithiasis. 2016.
Park S, Pearle MS. Imaging for percutaneous renal access and management of renal calculi. Urol Clin North Am. 2006;33:353-64.
Agarwal M, Agrawal MS, Jaiswal A, Kumar D, Yadav H, Lavania P. Safety and efficacy of ultrasonography as an adjunct to fluoroscopy for renal access in percutaneous nephrolithotomy (PCNL). BJU Int. 2011;108:1346-9.
Mishra S, Sharma R, Garg C, Kurien A, Sabnis R, Desai M. Prospective comparative study of miniperc and standard PNL for treatment of 1 to 2 cm size renal stone. BJU Int. 2011;108:896-9; discussion 9-900.
Akman T, Binbay M, Ozgor F, et al. Comparison of percutaneous nephrolithotomy and retrograde flexible nephrolithotripsy for the management of 2-4 cm stones: a matched-pair analysis. BJU Int. 2012;109:1384-9.
Bryniarski P, Paradysz A, Zyczkowski M, Kupilas A, Nowakowski K, Bogacki R. A randomized controlled study to analyze the safety and efficacy of percutaneous nephrolithotripsy and retrograde intrarenal surgery in the management of renal stones more than 2 cm in diameter. J Endourol. 2012;26:52-7.
Mariappan P, Smith G, Bariol SV, Moussa SA, Tolley DA. Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy: a prospective clinical study. J Urol. 2005;173:1610-4.
Chen L, Xu QQ, Li JX, Xiong LL, Wang XF, Huang XB. Systemic inflammatory response syndrome after percutaneous nephrolithotomy: an assessment of risk factors. Int J Urol. 2008;15:1025-8.
Sharma K, Sankhwar SN, Goel A, Singh V, Sharma P, Garg Y. Factors predicting infectious complications following percutaneous nephrolithotomy. Urol Ann. 2016;8:434-8.