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

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,

Tam Metin

___

1. Urolithiasis - Guidelines - Uroweb 2022.
2. Labate G, Modi P, Timoney A, Cormio L, Zhang X, Louie M, et al. The percutaneous nephrolithotomy global study: classification of complications. J Endourol. 2011;25(8):1275–80.
3. Hosein M, Paskar D, Kodama R, Ditkofsky N. Coming together: A review of the American Association for the Surgery of Trauma’s Updated Kidney Injury Scale to facilitate multidisciplinary management. AJR Am J Roentgenol. 2019;213:1091–9.
4. Poudyal S. Current insights on haemorrhagic complica-tions in percutaneous nephrolithotomy ScienceDirect. Asian J Urol. 2022;9:81–93.
5. Kessaris DN, Bellman GC, Pardalidis NP, Smith AG. Management of hemorrhage after percutaneous renal surgery. J Urol. 1995;153(3 Pt 1):604–8.
6. Wollin DA, Preminger GM. Percutaneous nephrolithotomy: complications and how to deal with them. Urolithiasis. 2018;46(1):87–97.
7. Alabat Roca A, Torrecilla Ortíz C, Cuadrado Campaña JM, Colom Freixas S, Fernández-Concha Schwalb J, Beato García S, et al. Hemorrhagic complicationes after percutaneous nephrolithotomy: The importance of an early endovascular management. Actas Urológicas Españolas (English Edition) 2021;45(10):635–41.
8. Liu Y, Zhu W, Zeng G. Percutaneous nephrolithotomy with suction: is this the future? Curr Opin Urol. 2021;31(2):95101.
9. El-Nahas AR, Nabeeh MA, Laymon M, Sheir KZ, El-Kappany HA, Osman Y. Preoperative risk factors for complications of percutaneous nephrolithotomy. Urolithiasis. 2021;49(2):15360.
10. Wei C, Zhang Y, Pokhrel G, Liu X, Gan J, Yu X, et al. Research progress of percutaneous nephrolithotomy. Int Urol Nephrol. 2018;50:807–17.
11. Lang EK. Percutaneous nephrostolithotomy and lithotripsy: a multi-institutional survey of complications. Radiology. 1987;162(1):25–30.
12. Skolarikos A, De La Rosette J. Prevention and treatment of complications following percutaneous nephrolithotomy. Curr Opin Urol. 2008;18(2):229–34.
13. Said SHA, Al Kadum Hassan MA, Ali RHG, Aghaways I, Kakamad FH, Mohammad KQ. Percutaneous nephrolithotomy;alarming variables for postoperative bleeding. Arab J Urol. 2017;15(1):24.
14. Kukreja R, Desai M, Patel S, Bapat S, Desai M. Factors affecting blood loss during percutaneous nephrolithotomy: prospective study. J Endourol. 2004;18(8):715–22.
15. Stoller ML, Wolf JS, And JR, Lezin MAS. Estimated blood loss and transfusion rates associated with pecutaneous nephrolithotomy. J Urol. 1994;152:1977–81.
16. Karalar M, Tuzel E, Keles I, Okur N, Sarici H, Ates M. Effects of parenchymal thickness and stone density values on percutaneous nephrolithotomy outcomes. Med Sci Monit. 2016;22:4363–8.
17. Tepeler A, Binbay M, Akman T, Erbin A, Kezer C, Silay MS, et al. Parenchymal thickness: does it have an impact on outcomes of percutaneous nephrolithotomy? Urol Int. 2013;90(4):40510.
18. Rifaioğlu MM, Önem K, Çelik H, Davarcı M, Çetinkaya M, İnci M, et al. Does renal parenchymal thickness affect bleeding in percutaneous nephrolithotomy? Turk J Med Sci. 2013;43:878–85.
19. Lee JK, Kim BS, Park YK. Predictive factors for bleeding during percutaneous nephrolithotomy. Korean J Urol. 2013;54(7):448–53.
20. Turna B, Nazli O, Demiryoguran S, Mammadov R, Cal C. Percutaneous nephrolithotomy: variables that influence hemorrhage. Urology. 2007;69(4):603–7.
21. Kocan H, Ozdemir E. Independent risk factors affecting hemorrhage in percutaneous nephrolithotomy: Retrospective study. Actas Urológicas Españolas (English Edition) 2022;46(9):544–9.
22. Parvex P, Pippi-Salle JL, Goodyer PR. Rapid loss of renal parenchyma after acute obstruction. Pediatr Nephrol. 2001;16(12):1076–9.
23. Beland MD, Walle NL, Machan JT, Cronan JJ. Renal cortical thickness measured at ultrasound: is it better than renal length as an indicator of renal function in chronic kidney disease? AJR Am J Roentgenol. 2010;195(2):W146–9.

___

Bibtex	@araştırma makalesi { kaftbd1357775, journal = {Kafkas Journal of Medical Sciences}, issn = {2146-2631}, eissn = {2587-053X}, address = {, publisher = {Kafkas Üniversitesi}, year = {2023}, volume = {13}, number = {2}, pages = {192 - 196}, title = {The Role of Parenchymal Thickness in Predicting the Amount of Bleeding During Percutaneous Nephrolithotomy}, key = {cite}, author = {Uslu, Mehmet and Yıldırım, Ümit and Ezer, Mehmet and Erihan, İsmet Bilger and Örs, Bumin} }
APA	Uslu, M. , Yıldırım, Ü. , Ezer, M. , Erihan, İ. B. & Örs, B. (2023). The Role of Parenchymal Thickness in Predicting the Amount of Bleeding During Percutaneous Nephrolithotomy . Kafkas Journal of Medical Sciences , 13 (2) , 192-196 .
MLA	Uslu, M. , Yıldırım, Ü. , Ezer, M. , Erihan, İ. B. , Örs, B. "The Role of Parenchymal Thickness in Predicting the Amount of Bleeding During Percutaneous Nephrolithotomy" . Kafkas Journal of Medical Sciences 13 (2023 ): 192-196 <
Chicago	Uslu, M. , Yıldırım, Ü. , Ezer, M. , Erihan, İ. B. , Örs, B. "The Role of Parenchymal Thickness in Predicting the Amount of Bleeding During Percutaneous Nephrolithotomy". Kafkas Journal of Medical Sciences 13 (2023 ): 192-196
RIS	TY - JOUR T1 - The Role of Parenchymal Thickness in Predicting the Amount of Bleeding During Percutaneous Nephrolithotomy AU - MehmetUslu, ÜmitYıldırım, MehmetEzer, İsmet BilgerErihan, BuminÖrs Y1 - 2023 PY - 2023 N1 - DO - T2 - Kafkas Journal of Medical Sciences JF - Journal JO - JOR SP - 192 EP - 196 VL - 13 IS - 2 SN - 2146-2631-2587-053X M3 - UR - Y2 - 2023 ER -
EndNote	%0 Kafkas Journal of Medical Sciences The Role of Parenchymal Thickness in Predicting the Amount of Bleeding During Percutaneous Nephrolithotomy %A Mehmet Uslu , Ümit Yıldırım , Mehmet Ezer , İsmet Bilger Erihan , Bumin Örs %T The Role of Parenchymal Thickness in Predicting the Amount of Bleeding During Percutaneous Nephrolithotomy %D 2023 %J Kafkas Journal of Medical Sciences %P 2146-2631-2587-053X %V 13 %N 2 %R %U
ISNAD	Uslu, Mehmet , Yıldırım, Ümit , Ezer, Mehmet , Erihan, İsmet Bilger , Örs, Bumin . "The Role of Parenchymal Thickness in Predicting the Amount of Bleeding During Percutaneous Nephrolithotomy". Kafkas Journal of Medical Sciences 13 / 2 (Ağustos 2023): 192-196 .
AMA	Uslu M. , Yıldırım Ü. , Ezer M. , Erihan İ. B. , Örs B. The Role of Parenchymal Thickness in Predicting the Amount of Bleeding During Percutaneous Nephrolithotomy. Kafkas Journal of Medical Sciences. 2023; 13(2): 192-196.
Vancouver	Uslu M. , Yıldırım Ü. , Ezer M. , Erihan İ. B. , Örs B. The Role of Parenchymal Thickness in Predicting the Amount of Bleeding During Percutaneous Nephrolithotomy. Kafkas Journal of Medical Sciences. 2023; 13(2): 192-196.
IEEE	M. Uslu , Ü. Yıldırım , M. Ezer , İ. B. Erihan ve B. Örs , "The Role of Parenchymal Thickness in Predicting the Amount of Bleeding During Percutaneous Nephrolithotomy", , c. 13, sayı. 2, ss. 192-196, Ağu. 2023