The Role of Parenchymal Thickness in Predicting the Amount of Bleeding During Percutaneous Nephrolithotomy

Abstract

Aim: Percutaneous nephrolithotomy (PCNL) is the approved firstline treatment for complicated kidney stones larger than 2 cm. One of the most prevalent problems during PCNL is bleeding. The majority of bleeding is managed with conservative methods. This study aims to investigate the potential effect of parencyhmal thickness on the likelihood of bleeding during PCNL surgery. Material and Method: The results of patients who underwent PCNL to treat kidney stones in our clinic between May 2016 and May 2022 were subjected to a retrospective data analysis. Demographic data of patients, characteristics of stones, operation time, access technique, pre-and postoperative hemogram values, transfusion, and renal parenchyma thickness were recorded. Results: Of the 181 patients included in the study, 127 were male, 54 were female, and the mean age was 45.22 (±14). The mean Charlson Comorbidity Index of the patients was found to be 0.93 (0–5). Right PCNL was performed in 75 patients, and left PCNL in 106 patients. The mean stone size was 26.16 mm (±9.9), stone surface area was 343.14 mm² (±81 - 1507), and the stone density was 1115.52 HU (±390.52). 27.1% of the stones were non-opaque. The average parenchymal thickness was measured at 18.82 mm (±4.68). Patients who received blood transfusion were excluded from the study. While all bleedings were managed conservatively, embolization and nephrectomy were not required. The mean decrease in hemoglobin was 2.02 g/dl (0–4.4). Four patients exhibited a postoperative fever. When Spearman’s correlation test was performed between the groups, a moderate correlation was observed between parenchymal thickness and hemoglobin decrease (p<0.01), and a weak correlation between stone surface area and hemoglobin decrease (p<0.05). Conclusion: As a result, the parenchymal thickness can guide surgeons in estimating bleeding and planning blood requirements before surgery.

Keywords

• percutaneous nephrolithotomy
• bleeding
• parenchymal thickness

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