NUMBER OF RENAL CALIX PUNCTURES AND BLOOD LOSS DURING PERCUTANEOUS NEPHROLITOTRIPSY. IS THERE A CORRELATION ?

Introduction & Objectives Percutaneous nephrolithotripsy is a strengthened procedure to solve staghorn or ESWL- refractory stones. Hemorrhagic complications are the most important. The aim of this work is to assess if there is a correlation between the number of percutaneous tract punctures with different techniques and post-operative blood loss. Material & Methods Between January 2002 to October 2005, 186 non consecutive, patients, mean age 52,1+ 16 years old (range 7-83 yrs) underwent percutaneous nephrolithotripsy. Essential criteria were: stone-free procedure in one step, single nephrostomy access, no contemporary auxiliary procedures executed (e.g endopielotomy). The nephrostomy tract was performed in 21 patients with Alken metallic dilation, in 17 pts with "One shot" procedure, in 57 pts with pneumatic dilation, in 58 with Teflon Amplatz procedure and in 33 pts with Mini-percutaneous access. The lithotripsy energy used was ultrasound in 2 cases, ballistic in 86 cases, in 25 cases ballistic/ ultrasound, in 37 cases with Holmium LASE& in 6 mechanic energy with forceps and in 30 cases only grasping was needed. We have considered: number of renal punctures, X-ray exposure time, pre and post-operative hemoglobin/haematocrits values, transfusion rate, hospital stay. The obtained data were divided into 4 different groups, in base of puncture's number (1 puncture: 36 pts-Group 1,2 punctures: 41 pts- Group2; 3punctures: 55ptsGroup3; >3punctures: 54pts-Group4).Thedatawere analyzedby F test analysis. Results The stone burden ranged from 7 to 60 mm, mean diameter 25,4 t 9,93mm; mean puncture number was 3,1t1,9, range froml to l0 punctures. X-ray mean exposure time was 5,9+3 minutes, ranged from 38 seconds to 17 minutes; mean blood loss was 1,6ltl,12 gldl hemoglobin (1,28+0,67 in group T; 1,21* 1,01 in group 2; 1,67*1,01 in group 3 and 2,49+1,32 in group 4) l0 pts were transfused: 6/10 with autologous blood, 4/10 with eterologous blood; mean hospital stay was 5,6+2 (range: 3-ll days). No statistical significant correlation was found with stone burden, type of percutaneous nephrostomy tract construction, type of lithotripsy energy used and blood loss. Besides, there were no statistical significant data between groups 1,2,3 about number of calix punctures, but there was high correlation in blood loss regarding group 4 compared to groups 1,2,3 (p<0.05); we have reconfirmed previous dxa about less X-ray exposure using One-shot percutaneous procedure as effective as others techniques (4,89+2 minutes versus 6,33*3,7 minutes; p<0.001). The hospital stay was similar in all groups. Conclusions It's known that the success of percutaneous procedure depends on the correct access to selected renal calyx. Our data demonstrate that, in selected patients, energy sources and techniques of percutaneous accesses don't link to hemorrhagic risk, being blood loss influenced significantly by the number of renal punctures.