Comparative Analysis of Blood Loss and Transfusion Requirements Among Patients with Staghorn Calculus Undergoing Percutaneous Nephrolithotomy versus Open Stone Surgery in National Kidney and Transplant Institute: 2018-2019

Abstract

Objective: Percutaneous nephrolithotomy (PCNL) is the standard of care for the treatment of renal stones >2cm and staghorn calculi. This minimally invasive procedure however has intraoperative hemorrhage as one of its most dreaded complications.

Objective: To analyze the rate of hemorrhage and transfusion requirements among patients undergoing either PCNL or open stone surgery (OSS).

Methods: This was a retrospective study conducted at the National Kidney and Transplant Institute Medical Records Department. Data were collected for the period of January 2018 to December 2019.

Results: One hundred forty cases were included, 102 patients in the PCNL group and 38 in the OSS. The mean age 50.84±11.89 vs. 50.50±10.09 with male to female ratio of 1.2:1 for PCNL and open surgery, respectively. The most common comorbidity was hypertension (89, 63.6%). As regards stone size, majority had >4 cm stone size (61; 43.9%). In PCNL, there was no significant change noted in the hemoglobin (14.69±13.3 vs 12.03±1.91, p= 0.099) as compared to OSS, where there was significant decline (12.77±2.64 vs. 11.06±2.52; = .000. The number of packed red cell units for transfusion was also significantly higher in OSS compared to PCNL group (.526±.861 vs. 159±.502, p .020.)

Conclusion: In the treatment of staghorn calculi, PCNL incurs less blood loss and lower transfusion requirements compared to open stone surgery.