Abstract
ObjectiveIn this study, we aimed to determine the correlation between the STONE score [(S)ize of the stone, (T)opography or location, degree of (O)bstruction of the urinary system, (N)umber of stones, and (E)valuation of Hounsfield units] and postoperative hemoglobin drop in patients undergoing percutaneous nephrolithotomy (PCNL).MethodsThis was a prospective observational study and all adult patients aged 18-65 years undergoing unilateral, single-tract PCNL using 26 Ch. Amplatz sheath for renal calculi were included. The five variables of the STONE nephrolithometry score were calculated prior to the procedure. The stone-free rates were assessed on imaging at four weeks and complications were graded using the modified Clavien system.ResultsOf the 142 patients included, 75% were below 55 years of age. More than half of our patients were diabetic with more than 60% having a body mass index (BMI) above 25 kg/m2. The mean STONE score was 7 with 33% having a high (>9) STONE score. The mean hemoglobin drop was 1.15 +0.92 g/dL with eight patients (5.63%) requiring transfusion and one (0.7%) requiring angioembolization; one patient required readmission for observation. Complete STONE clearance was achieved with PCNL alone in 78.2% of the patients. There was a significant correlation of hemoglobin drop with the STONE score, stone size, and preoperative creatinine clearance. Patients with a hemoglobin drop of >1 g/dL had a higher STONE score and mean stone size. The overall complication rate was significantly higher (10.5%) in patients with a hemoglobin drop of >1 g/dL as compared to those with a hemoglobin drop of <1 g/dL (2.8%).ConclusionStone complexity as measured by the STONE score correlates with post-PCNL hemoglobin drop, stone clearance, and complication rates. The STONE score may be used for preoperative counseling and to evaluate the potential need for transfusion.
Highlights
Percutaneous nephrolithotomy (PCNL) is considered to be the standard treatment for moderate to largesized renal calculi
More than half of our patients were diabetic with more than 60% having a body mass index (BMI) above 25 kg/m2
Complete STONE clearance was achieved with PCNL alone in 78.2% of the patients
Summary
Percutaneous nephrolithotomy (PCNL) is considered to be the standard treatment for moderate to largesized renal calculi. It is minimally invasive and generally considered a safe and highly effective procedure. Often minimal and self-limiting, and it can be life-threatening, requiring transfusions and angioembolization in rare cases. The need for transfusion varies from 1-11% [1,2,3,4], and up to 0.8% of the patients require angioembolization [5]. The predictors of postoperative bleeding include patient-related factors such as age [3], presence of diabetes mellitus (both type 1 and 2) [4], urinary tract infections [3], and preoperative hemoglobin levels, and stonerelated factors such as large stones, staghorn calculi, stone location, the grade of hydronephrosis, and renal parenchymal thickness [6]. Perioperative factors like multiple access and prolonged surgery time can influence postoperative bleeding [7]
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