Investigating the Factors Related to the Amount of Bleeding Due to Percutaneous Nephrolithotomy (PCNL)

Background: Hemorrhage remains a major concern during percutaneous nephrolithotomy (PCNL). The present study focused on determining the contributing factors to blood loss throughout the procedure. Methods: In this prospective study, we assessed 412 individuals who underwent PCNL at our center from June 2020 to June 2024. Hemoglobin drop post-surgery, adjusted for transfused blood volume, was used to estimate total blood loss. A stepwise multivariate regression model was applied to explore the correlations between bleeding volume or transfusion requirement and multiple patient-specific or procedural variables. Results: The average hemoglobin reduction observed was 1.57 ± 2.43 g/dL. Significant predictors of blood loss included Body Mass Index (BMI) (P < 0.05), stone dimensions (P < 0.05), presence of multiple stones (P < 0.05), upper calyceal stone location (P < 0.05), insertion of two or more nephrostomy tubes (P < 0.05), surgery duration (P < 0.05), and diabetes (P < 0.05). A transfusion was required in 3.5% of patients. Conclusions: Increased intraoperative blood loss following PCNL was significantly associated with higher BMI, greater stone burden, multiple stones, upper calyceal location, prolonged surgical time, multiple nephrostomy insertions, and diabetes mellitus.