3:36 PM Abstract No. 112 Hemorrhagic complications of percutaneous nephrolithotomy: factors affecting the complications

Abstract

To elucidate factors affecting hemorrhagic complications of percutaneous nephrolithotomy (PCNL). Between April 2012 and January 2018, 196 kidneys (right/left: 85/111) in 188 patients (male/female: 83/105, median age: 66) with nephrolithiasis were treated with PCNL. Renal access was obtained mostly through a stone-bearing calyx (79.6%) in the angiography suite prior to PCNL. Medical records and imaging studies were reviewed to record hemorrhagic complications of PCNL, which required abortion of PCNL, blood transfusion, or CT angiography with/without angioembolization. To elucidate the factors affecting the hemorrhagic complications, binary logistic regression analyses were conducted with variables from patients’ demographics (age, sex, body mass index (BMI)), stone characteristics (size, location, CT density, complete or partial staghorn vs. non-staghorn, chemical composition/calcium oxalate-dominance), renal access characteristics (number of calyces punctured, number of renal access for PCNL obtained, accessed calyx (upper, mid, lower), fluoroscopy time/dose) and PCNL characteristics (operator (senior vs. junior), operation time). Of 196 PCNL procedures, 18 (9.2%) were associated with hemorrhagic complications including 5 (2.6%) requiring angioembolization. In univariate analysis, BMI<20 (P = 0.047), complete staghorn (P = 0.047), upper pole stone (P = 0.02), multiple accesses (P <0.01) and renal access fluoroscopy time (P = 0.03) were significant risk factors for hemorrhagic complications of PCNL. Stone composition/calcium oxalate dominance (P = 0.75), PCNL operator (P = 0.15) and operation time (P = 0.25) were not the significant risk factors. In multivariate analysis, BMI<20 (odds ratio (OR) 6.74, confidence interval (CI) 1.50-30.3, P = 0.013), multiple accesses (OR 9.82, CI 2.65-36.4, P = 0.001) and renal access fluoroscopy time (OR 1.04, CI 1.004-1.075, P = 0.028) remained statistically significant. Although hemorrhagic complications of PCNL could be multifactorial, renal access techniques appear to affect the complications. Prolonged manipulation for renal access and PCNL through multiple accesses, especially in patients with BMI<20, may increase the chance of the hemorrhagic complications.