COMPARISON OF INTRAOPERATIVE BLOOD LOSS IN PATIENTS WITH AND WITHOUT PREVIOUS OPEN RENAL STONE SURGERY ON IPSILATERAL SIDE UNDERGOING PERCUTANEOUS NEPHROLITHOTOMY

Abstract

Background: Percutaneous nephrolithotomy (PCNL) is the gold standard for treating kidney stones larger than 20 mm, but blood loss remains a significant complication. Previous open renal stone surgery (POS) has been reported as a risk factor for increased blood loss during PCNL. This study aimed to compare intraoperative blood loss in patients with and without a history of POS undergoing PCNL.

Objective: To compare the intraoperative blood loss in patients with a history of previous open renal stone surgery (POS) versus patients without a history of POS undergoing percutaneous nephrolithotomy (PCNL).

Method: This quasi-experimental study was conducted at the Department of Urology, Sir Ganga Ram Hospital, Lahore, Pakistan, from January to December Sixty-eight patients were divided into two groups of 34 each: Group A with a history of POS on the ipsilateral side and Group B with primary PCNL. Demographic details, stone characteristics from non-contrast CT scans, and complete blood counts before and after PCNL were recorded. Blood loss was calculated based on the difference in pre- and postoperative hemoglobin levels and the number of blood pints transfused. Data were analyzed using SPSS version 26.

Result: The average age in Group A was 50.0±7.9 years and in Group B was 41.2±11.3 years. There were no significant differences in gender distribution, stone location, or stone size between the groups. The mean drop in hemoglobin level was 0.34±0.21 g/dl in Group B and 0.23±0.33 g/dl in Group A (p=0.265). Three patients (8.8%) in Group A required blood transfusion postoperatively, compared to none in Group B (p=0.076). The median hospital length of stay was significantly longer in Group A (4.0 days) than in Group B (3.0 days) (p=0.042).

Conclusion: PCNL is an effective and safe procedure for treating kidney stones in patients with or without a history of POS in terms of blood loss. However, patients with a history of POS may have a longer hospital stay.