Category: Clinical Stones: PCNL

MP7-2 - Risk factors for blood transfusion following percutaneous nephrolithotomy in the UK.

Fri, Sep 21
10:00 AM - 12:00 PM

Introduction & Objective :

Percutaneous nephrolithotomy (PCNL) is routinely utilized in the management of large renal stones and staghorn calculi. PCNL is more efficacious when compared to other treatment modalities but carries an increased risk of morbidity. Vascular injury and hemorrhage are known complications of PCNL with associated risk of blood transfusion. We sought to describe procedural and patient risk factors for blood transfusion using a national prospective data registry.

Methods :

Data submitted to the BAUS PCNL data registry between 2011 and 2017 were analyzed for rates of blood transfusion. We assessed risk factors for transfusion, including operator performing renal puncture (urologist versus radiologist), patient position (prone versus supine), size of renal access (6-24 French versus 25-30 French), stone size (< 2 cm versus >2 cm), stone complexity defined by Guy’s stone score (I-II versus III-IV), patient comorbidities (spina bifida, kyphoscoliosis, and spinal cord injury), BMI, and preoperative hemoglobin.

Results :

Of 9,139 PCNL’s, 198 patients required blood transfusion (2.2%). Significantly greater transfusion rates were observed for more complex stones, larger stones, larger renal access size, and preop Hb <120 (Table 1). Underweight patients and patients with normal BMI had higher transfusion rates when compared to overweight and obese patients. No difference was observed with patient position, patient comorbidity, or operator performing renal puncture.

Conclusions :

Risk of transfusion after PCNL increases with larger more complex stones and when larger renal access size is used. Patients with low preoperative Hb and with lower BMI may be at increased risk for transfusion.

Adam Althaus

Senior Clinical Fellow
Addenbrooke's Hospital
Cambridge, England, United Kingdom

John Withington

Urology Registrar
Royal Free Hospital NHS Trust
London, England, United Kingdom

William Finch

Consultant Urological Surgeon
Norfolk and Norwich University Hospitals
Norwich, England, United Kingdom

Daron Smith

Consultant Urological Surgeon
Stone and Endourology Unit, Institute of Urology, University College London Hospitals NHS Foundation Trust
London, England, United Kingdom

Daron Smith is a consultant urological surgeon at the Institute of Urology at University College Hospital. His practice is "endoluminal endourology" and encompasses the comprehensive management of Urinary Tract Stone disease, and includes the endourological management of ureteric obstruction, ureteric injuries, and the endoscopic diagnosis and management of upper tract TCC. He is the vice-chairman of the BAUS Section of Endourology, having been its Secretary from 2015-17 and a committee member since 2013, is the Consulting Editor on stone disease for the BJUI and the deputy editor of the Journal of Endoluminal Endourology

Ben W. Turney

Bernard Senior Clinical Researcher in Urology
Nuffield Department of Surgical Sciences
Oxford, England, United Kingdom

Sarah Fowler

London, England, United Kingdom

Jim Armitage

Cambridge, England, United Kingdom

Stuart Iriving

Norwich, England, United Kingdom

Neil Burgess

Norwich, England, United Kingdom

Oliver Wiseman

Cambridge University Hospitals, Urology, Cambridge, United Kingdom
CAMBRIDGE, England, United Kingdom

Oliver is a Consultant Urologist based at Cambridge University Teaching Hospitaks NHS Trust Cambridge, UK. He specialises in the treatment of kidney stones, their metabolic management and in the devlopment of patient reported outcomes for stone disease. He runs a number of training courses teaching stone surgery, and has been invited to operate and lecture nationally and internationally on stone disease.
He qualified in Cambridge and following basic surgical training, he underwent specialist training in urology in London, including at Guys Hospital and UCLH ("The Institute of Urology"). He has published widely including articles relating to the management of patients with renal stone disease.
He is a trustee of BAUS, honorary treasurer elect of BAUS, a member of the BAUS Section of Endourology Committee, and on the Endourological Society Awards and Medals Committee. He is training program director for Urology for the East of England.