title: Comparing Bleeding Complications of Double and Single Access Totally Tubeless PCNL: Is It Safe to Obtain More Accesses?
abstract: OBJECTIVE
  To assess bleeding complications in totally tubeless double-access percutaneous nephrolithotomy (PCNL) and compare it with the single-access method.
  
  
  METHODS
  One hundred and seven patients with large or scattered renal stones were enrolled in this cohort study. Totally tubeless PCNL with one access (group A, 70 cases) or two accesses (group B, 37 cases) was done and bleeding was assessed by measuring the hemoglobin drop of the patients, blood transfusion rate and need for performing angioembolization.
  
  
  RESULTS
  The mean (SD) hemoglobin drops in groups A and B were 1.97 (1.24) and 2.31 (1.24), respectively; p = 0.176. Blood transfusion rates in two groups were 7.1 and 10.8% (p = 0.716), respectively. None of our patients required angioembolization. The average hemoglobin drop and blood transfusion rate with double tracts were approximately near to those in single tract group and in acceptable ranges. The average hospital stay in groups A and B were 3.1 and 3.2 days (p = 0.074), respectively. There was no leakage from puncture site/s and stone free rates in the two groups were 85.7 and 97.3% (p = 0.093).
  
  
  CONCLUSIONS
  Totally tubeless double-access PCNL is feasible and bleeding complications are comparable to single access totally tubeless PCNL making it an effective strategy to achieve more stone free rates.
authors.affiliation: Department of Urology, Tehran University of Medical Sciences, Sina Hospital, Tehran, Iran.
authors.forename: Seyed Mohammad Kazem
authors.initials: SM
authors.lastname: Aghamir
authors.forename: Reza
authors.initials: R
authors.lastname: Elmimehr
authors.forename: Seyed Saeed
authors.initials: SS
authors.lastname: Modaresi
authors.forename: Alborz
authors.initials: A
authors.lastname: Salavati
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D004621:Embolization, Therapeutic; D004867:Equipment Design; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D007669:Kidney Calculi / Q000097:blood / Q000175:diagnosis* / Q000628:therapy*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000295:instrumentation / Q000379:methods*; D061214:Patient Safety; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D006454:Hemoglobins