title: Percutaneous nephrolithotomy: variables that influence hemorrhage.
abstract: OBJECTIVE
  Renal hemorrhage is one of the most common and worrisome complications of percutaneous nephrolithotomy (PCNL). This study attempted to identify variables that might influence hemorrhage during PCNL to help urologists establish preventative and treatment strategies for bleeding during PCNL procedures.
  
  
  METHODS
  The data of 193 patients (193 PCNL procedures) were retrospectively analyzed. Hemorrhage was estimated by the postoperative decrease in hematocrit factored by the quantity of any blood transfusion. Various preoperative and operative factors were assessed for their association with blood loss using univariate, forward multivariate regression and correlation analysis.
  
  
  RESULTS
  The mean patient age was 45.7 +/- 14.4 years (range 5 to 74). The overall stone-free rate was 85.4%. The average hematocrit decrease was 8.7% +/- 5.39% (range 0.3 to 24.7). Forward multivariate regression analysis identified five significant variables that influenced PCNL-related hemorrhage: stone type (P = 0.003), number of tracts (P = 0.010), method of dilation (P = 0.010), diabetes (P = 0.022), and stone surface area (P = 0.049). A statistically significant difference was found in relation to the occurrence of hemorrhage between patients with caliceal stones and partial staghorn stones (P = 0.008) and complete staghorn stones (P = 0.006), single tracts and multiple tracts (P = 0.038), balloon dilators and Amplatz dilators (P = 0.007), patients with small stones (1000 mm2 or smaller) and large stones (greater than 1000 mm2; P = 0.018) on univariate analysis. Also, the stone surface area (P = 0.019) and number of tracts (P = 0.024) showed a positive correlation with the mean hematocrit decrease.
  
  
  CONCLUSIONS
  Staghorn stones, multiple tracts, the presence of diabetes, and large stones were associated with increased renal hemorrhage during PCNL on multivariate analysis. However, balloon dilation was associated with decreased hemorrhage.
authors: Department of Urology, Ege University School of Medicine, Izmir, Turkey. burakturna@gmail.com
authors: Burak
authors: B
authors: Turna
authors: Oktay
authors: O
authors: Nazli
authors: Serkan
authors: S
authors: Demiryoguran
authors: Rashad
authors: R
authors: Mammadov
authors: Cag
authors: C
authors: Cal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects*; D012189:Retrospective Studies