Abstract
BackgroundTo explore the risk factors for severe bleeding complications after percutaneous nephrolithotomy (PCNL) according to the modified Clavien scoring system.MethodsWe retrospectively analysed 2981 patients who received percutaneous nephrolithotomies from January 2014 to December 2020. Study inclusion criteria were PCNL and postoperative mild or severe renal haemorrhage in accordance with the modified Clavien scoring system. Mild bleeding complications included Clavien 2, while severe bleeding complications were greater than Clavien 3a. It has a good prognosis and is more likely to be underestimated and ignored in retrospective studies in bleeding complications classified by Clavien 1, so no analysis about these was conducted in this study. Clinical features, medical comorbidities and perioperative characteristics were analysed. Chi-square, independent t tests, Pearson’s correlation, Fisher exact tests, Mann–Whitney and multivariate logistic regression were used as appropriate.ResultsOf the 2981 patients 70 (2.3%), met study inclusion criteria, consisting of 51 men and 19 women, 48 patients had severe bleeding complications. The remaining 22 patients had mild bleeding. Patients with postoperative severe bleeding complications were more likely to have no or slight degree of hydronephrosis and have no staghorn calculi on univariate analysis (p < 0.05). Staghorn calculi (OR, 95% CI, p value 0.218, 0.068–0.700, 0.010) and hydronephrosis (OR, 95% CI, p value 0.271, 0.083–0.887, 0.031) were independent predictors for severe bleeding via multivariate logistic regression analysis. Other factors, such as history of PCNL, multiple kidney stones, site of puncture calyx and mean corrected intraoperative haemoglobin drop were not related to postoperative severe bleedings.ConclusionsThe absence of staghorn calculi and a no or mild hydronephrosis were related to an increased risk of post-percutaneous nephrolithotomy severe bleeding complications.
Highlights
To explore the risk factors for severe bleeding complications after percutaneous nephrolithotomy (PCNL) according to the modified Clavien scoring system
According to our preoperative assessment, 62.9% of the cases suffered from flank pain, 7.1% of patients presented with a history of haematuria, and 92.9% had a history of previous urinary tract infections
Due to the simple treatment methods, such as using intravenous fluid without blood transfusion, requiring a single episode of nephrostomy clamping or skin compression/pressure dressing [19], minor bleeding only poses a slight threat to patients and has a lower rate of agreement with urologists [9], and cases of bleeding complications classified as Clavien 1 were not included in this research
Summary
To explore the risk factors for severe bleeding complications after percutaneous nephrolithotomy (PCNL) according to the modified Clavien scoring system. Severe bleeding after percutaneous nephrolithotomy is still a challenge for urologists. Surgery, including urology, has used the Clavien-Dindo classification system extensively [5, 6] due to its simplicity and usability in classifying postoperative complications [7]. Postoperative complications after urological surgery were recommended to be reported by the European Association of Urology (EAU) guidelines panel, and the Clavien-Dindo classification system was the primary choice [8]. In 2012 de la Rosette et al found that urologists tended to have a lower rate of agreement for grading minor complications (Clavien score 1) and best agreement was identified to define severe complications (Clavien greater than 3a) [9]
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