Analysis of the Risk Factors for Massive Hemorrhage after PCNL in the Oblique Supine Position

• Yifeng Gu ^[1] ; Yongchang Chen ^[1] ; Yan Zhao ^[2] ; Ge Zhang ^[1] ; Ke Lu ^[1] ; Jun Hu ^[1] ; Zhenyu Fu ^[1]
  1. [1] Department of Urology, Changshu No. 2 People’s Hospital, Changshu, Jiangsu, China
  2. [2] Department of Urology, Xuzhou Cancer Hospital, Affiliated Hospital of Jiangsu University, Xuzhou, Jiangsu, China
• Localización: Archivos españoles de urología, ISSN 0004-0614, Tomo 76, Nº. 9, 2023, págs. 696-702
• Idioma: inglés
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• Resumen

  • Background: Percutaneous nephrolithotomy (PCNL) is a proven and efficient treatment method; Nevertheless, it is essential to note that there is still a risk of significant bleeding. The purpose of this paper is to explore the risk factors for massive hemorrhage after PCNL in the oblique supine position and provide a basis for the development of measures to prevent massive hemorrhage.

    Methods: The clinical data of 97 patients who underwent PCNL in the oblique supine position at Changshu No. 2 People’s Hospital from January 2019 to December 2020 were retrospectively analyzed. Patients were placed in the massive hemorrhage group if their hemoglobin levels decreased by ≥20 g/L 24 h after the operation, and the other patients were placed in the nonmassive hemorrhage group. Differences in sex, age, body mass index (BMI), hypertension, diabetes, surgical side, perirenal fat stranding (PFS), calculus long diameter, surgical access, and operation time were compared between the two groups to determine the risk factors for massive bleeding. Multivariable logistic regression analysis was used to determine the risk factors for massive hemorrhage after PCNL.

    Results: There were no significant differences in sex, BMI, hypertension, diabetes, surgical side, or calculus long diameter between the two groups (p > 0.05), and there were statistically significant differences in age, PFS, surgical access, and operation time (p < 0.05). Multivariate logistic regression analysis indicated that PFS and extensive surgical access were independent risk factors (p < 0.05).

    Conclusions: PFS and extensive surgical access were independent risk factors. Carefully reading computed tomography (CT) films before surgery and reducing the size of the surgical access area are important measures for reducing the risk of massive hemorrhages.