The Association Between Renal Stone Complexity and the Amount of Postoperative Bleeding Following Percutaneous Nephrolithotomy

Abstract

Background: Percutaneous Nephrolithotomy (PCNL) is the primary therapy for large or complex kidney stones. Although effective, postoperative bleeding remains one of the most frequent major complications, with hemoglobin reduction (ΔHb) serving as an objective indicator of blood loss. Kidney stone complexity is suspected to play a significant role in determining the severity of bleeding. Objective: To evaluate the association between kidney stone complexity and the degree of bleeding following PCNL. Methods: This analytical observational study employed a cross-sectional design involving 58 nephrolithiasis patients undergoing PCNL at RSUP Prof. Ngoerah, RS Surya Husadha, and RS Bali Royal Hospital in 2024. Stone complexity was classified as staghorn and non-staghorn. Bleeding severity was determined based on ΔHb, with ≤1 g/dL categorized as mild bleeding and >1 g/dL as severe bleeding. The Chi-Square test was used to assess the association, with statistical significance set at p < 0.05. Results: Most patients had non-staghorn kidney stones (53.4%), and severe bleeding was observed in 62.1% of subjects. A significant association was found between stone complexity and bleeding severity (p = 0.021). Patients with staghorn stones demonstrated a higher proportion of severe bleeding (77.8%), whereas mild bleeding was more commonly observed in the non-staghorn group (51.6%). Conclusion: Kidney stone complexity is significantly associated with increased bleeding severity following PCNL. Stone complexity should therefore be considered an important factor in operative planning and risk management strategies for bleeding.