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Year : 1998  |  Volume : 14  |  Issue : 1  |  Page : 9-16

Factors affecting blood loss during percutaneous nephrolithotomy

Muljibhai Patel Urological Hospital, Nadiad

Correspondence Address:
R Gune
Muljibhai Patel Urological Hospital, Nadiad

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Source of Support: None, Conflict of Interest: None

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Bleeding occurs even in apparently uneventful Percutaneous Nephrolithotomy (PCNL) procedures. A prospective study was carried out to identify and analyse factors influencing blood loss. Baseline average hemoglobin loss was estimated by a retrospective analysis of 77 consecutive single stage uncomplicated PCNL (Group A). In the prospective study (Group B) 95 procedures in 85 consecutive cases of calculi treated by PCNL from December 96 to May 97 without operative or technical complications were evaluated. Average drop in hemoglobin in the retrospective group was 1.58 gms percent prospective group was 1.64 gms percent. The factors evaluated were (a) Pre-existing factors: diabetes, hypertension, previous interventions, stone location and burden, (b)Intraoperative factors: procedure time, tract maturity, access calyx, number of punctures and stages. Factors, which did not significantly affect the drop in hemoglobin were controlled diabetes and hypertension, previous endourological manipulations and solitary pelvic stones. Upper ureteric stones, single stage, single puncture procedures, mature tract and procedures where time was limited to 45 mins. had significantly less drop in hemoglobin. Statistically significant drop in hemoglobin was noted in patients with staghorn calculi, procedure time more than 90 min., multiple punctures and multiple stages. Transfusion rate was 3.52 percent. Tailoring operative strategy for individual cases with factors like presence of large stone burden, who may require multiple punctures and in whom multiple stages may be required for clearance will go a long way in minimizing blood loss.

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