Blood loss predictive factors and transfusion practice during percutaneous nephrolithotomy of kidney stones: a prospective study

Firtantyo Adi Syahputra; Ponco Birowo; Nur Rasyid; Faisal Abdi Matondang; Endrika Noviandrini; Maruto Harjanggi Huseini

doi:10.12688/f1000research.8993.1

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Research Article

Blood loss predictive factors and transfusion practice during percutaneous nephrolithotomy of kidney stones: a prospective study

[version 1; peer review: 1 approved, 2 approved with reservations]

Firtantyo Adi Syahputra¹, Ponco Birowo¹, Nur Rasyid¹, Faisal Abdi Matondang¹, Endrika Noviandrini¹, Maruto Harjanggi Huseini¹

Firtantyo Adi Syahputra¹, Ponco Birowo¹, [...] Nur Rasyid¹, Faisal Abdi Matondang¹, Endrika Noviandrini¹, Maruto Harjanggi Huseini¹

PUBLISHED 30 Jun 2016

Author details Author details

¹ Department of Urology, Cipto Mangunkusumo Hospital, faculty of Medicine, Jakarta, 10430, Indonesia

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Objectives
Bleeding is the most common complication of percutaneous nephrolithotomy (PCNL). Injudicious transfusion is frequently performed in current practice, even though it is not always needed. This study aimed to identify the predictive factors of blood loss in the PCNL procedure and evaluate the perioperative transfusion practice.

Methods
A prospective study of PCNL was randomly performed by two consultants of endo-urology at our institution. The inclusion criteria were adults with kidney pelvic stones >20 mm or stone in inferior calyx >10 mm or staghorn stone. Those with coagulopathy, under anti-coagulant treatment or open conversion were excluded. A full blood count was taken at baseline and during 12, 24, 36, 72-hours post-operatively. Factors such as stone burden, sex, body surface area, shifting of hematocrit level and amount of blood transfused were analyzed statistically using line regression to identify the predictive factors of total blood loss (TBL).

Results
Eighty-five patients were enrolled in this study. Mean TBL was 560.92 ± 428.43 mL for both endo-urology surgeons. Stone burden was the most influential factor for TBL (p=0.037). Our results revealed that TBL (mL) = -153.379 + 0.229 × stone burden (mm2) + 0.203 x baseline serum hematocrit (%); thus considerably predicted the need for blood transfusion. A total of 87.1% patients did not receive perioperative transfusion, 3.5% received intra-operative transfusion, 7.1% received post-operative transfusion, 23% had both intra and post-operative transfusion, resulting in a cross-matched transfusion ratio of 7.72. Mean perioperative blood transfused was 356.00 ± 145.88 mL.

Keywords

Bleeding, nephrolithiasis, PCNL, transfusion

Corresponding authors: Firtantyo Adi Syahputra, Ponco Birowo

Competing interests: No competing interests were disclosed.

Grant information: Cipto Mangunkusumo Hospital Operational Research Grant 2013 funded this research.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Copyright: © 2016 Syahputra FA et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Data associated with the article are available under the terms of the Creative Commons Zero "No rights reserved" data waiver (CC0 1.0 Public domain dedication).

How to cite: Syahputra FA, Birowo P, Rasyid N et al. Blood loss predictive factors and transfusion practice during percutaneous nephrolithotomy of kidney stones: a prospective study [version 1; peer review: 1 approved, 2 approved with reservations]. F1000Research 2016, 5:1550 (https://doi.org/10.12688/f1000research.8993.1) First published: 30 Jun 2016, 5:1550 (https://doi.org/10.12688/f1000research.8993.1) Latest published: 30 Jun 2016, 5:1550 (https://doi.org/10.12688/f1000research.8993.1)

Introduction

Kidney stones prove to be a common affliction in many countries worldwide because of high incidence and prevalence. In America, kidney stone incidence was found in 116 out of 100,000 individuals¹. A higher incidence was discovered in the German population aged 14 years and older, amounting to 720 out of 100,000 individuals². An excessively high number of cases was found in Asian countries, namely, 114.3 per 100,000 in Japan, while Iranian urolithiasis incidence was assessed at 145.1 in 2005³. A global increase in kidney stone cases was determined in individuals of all ages, sex, and races⁴. In our institution we have, to date, treated an increasing number of kidney stone patients, from 182 in 1997 to 847 in 2002⁵.

Percutaneous nephrolithotomy (PCNL) is a urological minimally-invasive procedure to extract kidney stones by means of percutaneous access⁶. Nowadays, PCNL is widely accepted to treat those complex kidney stone cases that are hard in consistency, of a large size, infected, obstructed with anatomical abnormalities, generally cases that could not be treated by other modalities⁷. In European guidelines, PCNL is favoured as the treatment of choice for calyx and pelvic stones >20 mm²⁸. For stones >20 mm, PCNL demonstrated a stone-free rate up to 78–95%⁹. There has been a decrease in open surgery number in our institution during 2001–2009, whereby the PCNL procedure has become more frequent¹⁰.

One of the most bothersome complications of PCNL is hemorrhage. Direct access to the pelvicalyceal system and intrarenal manipulation during PCNL procedures cause injury to the renal vasculature, particularly to the segmental and interlobar arteries. The renal-collecting system is rich in vascularization, covering 20% of the total cardiac output, and often results in hemorrhage during PCNL¹¹. The high percentage of blood loss and the necessity of transfusion often results in the erroneous management of hemorrhage during the PCNL procedure.

It has been reported that 1–11% of patients who underwent PCNL required blood transfusion; a higher transfusion rate, 2–53% was determined in the staghorn cases¹¹. Previous studies describe many hemorrhage risk factors during PCNL, such as, age¹², pre-operative urinary tract infections¹², large stones (exceeding 1250 mm²)¹³, staghorn calculi^13,14, multiple access^11,13,14, diabetes mellitus^11,13,15, prolonged surgery time^11–13 and stone composition¹³. Other risk factors have been postulated: i.e. stone location, pre-operative hemoglobin, hydronephrosis grade, renal parenchymal thickness, however, to date, have not yet been proven. Many of the hemorrhage cases during PCNL could be managed conservatively, however, 0.8% patients required a more invasive procedure to deal with the bleeding¹⁴.

To date there are no specific data available to determine the blood transfusion requirement during PCNL procedures. In our institution, blood units are requested pre-operatively according to clinical estimation. However, this does not always concede to the intra-operative blood loss. This study was aimed at predicting the amount of blood loss during PCNL by identifying the pre-operative factors that could possibly lead to a lower morbidity rate.

Materials and methods

The present study includes patients who underwent percutaneous nephrolithotomy procedure in our hospital from October 2012 to October 2013. Adult patients (≥18 years old) with pelvic stones >20 mm, inferior calyx stones >10 mm or staghorn stones who agreed to enroll by written informed consent were included in this study. Those with coagulopathy, under anti-coagulant treatment or conversion to open procedure were excluded.

Patients were admitted the day prior to procedure. Stone burden was assessed pre-operatively by multiplying sum of length and width by means of imaging. The PCNL was randomly performed under spinal anesthesia by two endo-urology consultants. The patient was placed in prone position, access gained to pelvicalyceal system with fluoroscopic guidance, followed by dilatation using a metal and fascia dilator before application of sheath. The number and location of punctures were decided intra-operatively, based on pelvicalyceal system. We used pneumatic lithotripsy to break the stone which was subsequently extracted by forceps or grasper. The procedure was completed when the patient was stone-free and any arising complications alleviated.

Full blood counts were taken prior to procedure and thereafter at 12, 24, 36, 72-hours post-operatively. Total blood loss was calculated considering body surface area, sex-adjusted estimated blood volume, initial hematocrit level and 72-hour post-operative hematocrit level. Study protocol has been approved by the Ethical Committee, Faculty of Medicine, Universitas Indonesia (No.89/H2.F1/ETIK/2013).

We compiled a chart^15,16 to assess total blood loss (TBL) to include sex, body surface area, shifting of hematocrit level and amount of blood transfused, as shown in Table 1.

Table 1. Operational definition.

Variable	Formula
Body Surface Area (m²)¹⁵	0.0235 × [Height (cm)]^0.42246 × [BW (kg)]^0.51456
Estimated Blood Volume (mL)¹⁵	Female: [Body Surface Area (m²)] × 2430
Estimated Blood Volume (mL)¹⁵	Male: [Body Surface Area (m²)] × 2530
Initial RBC (mL)¹⁵	[Estimated Blood Volume (mL)] × [Initial Hematocrit level 24-hour pre-op (%)]
Final RBC (mL)¹⁵	[Estimated Blood Volume (mL)] ×[Final Hematocrit level 72-hour post-op (%)]
Uncompensated RBC Loss (mL)¹⁵	[Initial RBC (mL)] – [Final RBC (mL)]
Compensated RBC Loss (mL)¹⁵	[Amount of RBC transfused from intra-op to 72-hour post-op]
Total RBC Loss (mL)¹⁵	[Uncompensated RBC Loss (mL)] + [Compensated RBC Loss (mL)]
Total Blood Loss (mL)¹⁶	$\frac{[Total RBC Loss (mL)]}{[1 / 2 \times (Hematocrit 24- hour pre-op + Hematocrit 72- hour post-op)]}$
Cross match transfusion ratio/CT ratio¹⁷	Amount of blood unit cross-matched : Amount of blood unit transfused
Under-transfusion¹⁸	Defined as blood volume transfused deficit less than 15.0% of total blood loss (mL)
Over-transfusion¹⁸	Defined as blood volume transfused excess greater than 15.0% of total blood loss (mL)

Abbreviations: RBC = red blood cell, BW = body weight

Bivariate analysis was done by correlating numerical variables with total blood loss, and associating categorical variables with perioperative blood transfusion amount. Those with significancy of <0.25 were further analyzed with multivariate analysis of linier and logistic regression.

Results

A total of 85 PCNL procedures were performed on 85 patients (46 males, 39 females) who completed this study, thus gave statistical power of 0.8. The average age was 50.96 ± 11.87 years. Most of the patients complained of flank pain at initial presentation (Table 2). Staghorn calculi were found in 50.6% patients.

Table 2. Patient Characteristics (n=85).

Variable		Number (Percentages)
Sex	Male	46 (54.1%)
Sex	Female	39 (45.9%)
Symptoms	Renal colic	17 (20.2%)
	Flank pain	76 (89.3%)
	Passing stone	29 (34.5%)
	Sandy urination	10 (11.9%)
	Haematuria	18 (21.4%)
	Dysuria	3 (3.6%)
	Fever	4 (4.8%)
	Urinary retention	2 (2.4%)
	Intermittency	2 (2.4%)
Stone Side	Right	50 (59.0%)
Stone Side	Left	35 (41.0%)

The mean hematocrit drop was 5.20 ± 3.36%. Average total blood loss was 560.92 ± 428.43 mL with median 511.46 (95% CI: 0.00-1974.84) mL. There were two cases with pelvicalyceal laceration, one with massive hemorrhage (perioperative blood loss 1974.84 mL). There was no significant difference of total blood loss between the cases performed by the two PCNL surgeons (p>0.05).

Stepwise multivariate regression analysis which included variables with p-value < 0.25 (Table 3) showed that stone burden was the most influential predictor of blood loss (p=0.037). Meanwhile operative time was found not associated (p-value >0.05) with blood loss. We assessed total blood loss (in mL) as -153.379 + 0.229 × stone burden (mm²) + 0.203 × serum hematocrit baseline (%). This means it is predicted that a kidney stone patient with 1000 mm² stone burden and baseline hematocrit 40% will have 83.74 mL blood loss during PCNL procedure perioperative.

Table 3. Bivariate analysis between related factors and total blood loss.

Variable	p-Value	R
Stone burden**	0.067	0.200
Number of stones**	0.380	0.096
Serum creatinine baseline**	0.549	0.066
Red blood cell count**	0.095	0.182
Serum hematocrit baseline*	0.135	0.163
Serum hemoglobin baseline**	0.501	0.074
Body mass index**	0.298	0.114
Age*	0.670	0.047

*Pearson analysis **Spearman analysis

The average amount of blood units 435.29 ± 114.13 mL was cross-matched for each procedure pre-operatively (Table 4). Nevertheless, 87.1% of patients did not receive blood transfusion perioperatively, thus yielding the blood transfusion rate as 12.9%. Blood transfusion was required by 3.5% patients intra-operatively, 7.1% post-operatively and 2.3% both intra and post-operatively. In total, the cross-matched transfusion ratio was 7.72. The average amount of blood transfused during PCNL procedure: 356.00 ± 145.88 mL.

Table 4. Blood transfusion pattern.

Blood Transfusion Proportion (%)		Average amount of blood unit cross- matched	Average amount of blood transfused (Intra-op – 72-hour post-op)	>Under- transfusion (%)	>Over- transfusion(%)
No transfusion	87.1%	435.29 ± 114.13 mL	356.00 ± 145.88 mL	0%	100%
Intra-operative transfusion	3.5%	Cross Match Transfusion Ratio
Post-operative transfusion	7.1%	7.72
Both intra & post-operative transfusion	2.3%	7.72

Patient Number	Sex	Age (years)	Stone Burden (mm2)	Number of Stones	Baseline Serum Creatinine (mg/dl)	RBC (million cells/?l)	Baseline Hemoglobin (g/dl)	Baseline Hematocrit (%)	Body Mass index	Total Blood Loss (ml)
1	Male	51	5	1	1.9	13.39	13.8	37.9	24.39	0
2	Male	68	5.5	2	1.4	4.68	14.2	40.9	26.45	1559.49
3	Male	68	1520	1	2.1	3.82	10.9	31.3	23.05	1246.8
4	Female	64	5	1	4.6	3.11	8.9	27.6	22.06	441.37
5	Male	58	3.15	1	2.6	3.84	12.5	37.5	29.76	148.13
6	Male	70	2650	1	1.1	4.02	10.3	29.5	27.18	1320.32
7	Female	71	1425	3	1.1	4.87	12.3	40	24.45	605.02
8	Male	49	1500	1	1	4.67	16.1	46.7	25.71	845.46
9	Female	46	486	4	1	4.84	13	40.4	28.57	696.46
10	Female	66	736	1	1.1	4.47	12.4	38.9	21.23	301.8
11	Male	30	722	3	1.1	5.44	15.5	46.8	23.83	221.44
12	Female	52	187	1	1.9	13.39	13.8	37.9	24.34	1635.48
13	Female	25	418	1	0.6	3.96	12.3	36.1	20.57	685.21
14	Female	20	1499	4	0.6	4.81	13.6	41.3	24.97	1974.84
15	Male	49	960	1	1.4	4.76	13.9	41.9	23.73	182.66
16	Male	51	163.8	2	1.1	4.04	12.6	35.6	25.96	0
17	Male	52	656	2	0.9	5.15	14.3	42.3	21.45	228.88
18	Male	41	11.44	2	1.4	5.37	15.5	45.7	19.59	164.22
19	Male	59	990	1	1.04	5.05	14.5	45.3	30.1	1321.48
20	Male	55	1775	3	5	2.98	8.8	25.2	23.31	434.29
21	Female	22	3.62	4	0.6	4.3	12.4	36.9	20.31	175.53
22	Female	44	1200	2	1.2	4.17	12.5	34.2	22.22	303.03
23	Female	38	1400	1	0.8	3.66	10.4	31.6	22.83	55.41
24	Male	44	1131	2	1.1	4.88	14	41.7	24.39	626.09
25	Female	72	1360	1	2.8	3.79	10	32.5	24.39	520.98
26	Female	54	55	3	1.9	3.68	10.9	32.9	16.18	608.33
27	Female	33	215	2	0.68	4.6	13.4	37.3	21.48	682.37
28	Male	43	460	1	0.9	4.66	13.8	40.6	20.2	353.21
29	Male	45	480	1	0.8	5.83	16	44.3	29.3	547.86
30	Female	54	786	2	0.9	4.03	12.3	35.5	29	46.5
31	Female	53	256	1	1.2	4.56	12.9	38.1	32.46	630.93
32	Female	56	1806	2	0.6	3.92	11.7	35.8	27.69	313.03
33	Female	68	5608	3	0.84	4.59	13.7	40.4	27.56	867.66
34	Female	51	322	1	0.6	4.63	13.6	39	28.4	214.87
35	Male	43	364	1	3.1	4.26	11.7	36.1	19.56	146.84
36	Female	57	578	2	0.8	4.54	13.9	41.1	31.64	79.6
37	Male	70	200	2	1.1	4.12	13.1	39.5	25.04	396.96
38	Male	19	121	1	1.1	5	14.2	42.9	33.33	307.66
39	Male	53	1907	2	5.2	3.68	9.2	28.5	22.66	873.87
40	Female	64	1476	1	1.9	4.07	10.2	31.5	19.15	88.7
41	Male	59	870	4	1.5	5.52	16.4	46.8	30.86	186.34
42	Female	48	58	3	3.9	4.48	13.2	41	32.05	234.05
43	Male	59	2480	2	8	3.46	10.1	30	20.57	1052.83
44	Male	57	640	2	2.7	3.77	11	34	20.83	521.63
45	Male	53	1200	1	1.52	5.3	13.7	42	24.69	653.29
46	Male	57	208	2	1.8	3.77	11.9	36	23.88	441.55
47	Female	54	380	4	1.4	4.22	12	36	21.36	0
48	Female	48	377	2	0.6	3.84	9	30	24.32	636.86
49	Male	56	1250	6	1.2	4.27	13.9	43	28.63	1106.5
50	Male	41	850	2	1.1	4.97	14.2	41	15.78	903.85
51	Male	43	2200	2	1.6	4.76	12.2	35.3	22.96	415.85
52	Female	53	1100	1	11	3.73	13.8	37.9	29.3	491.93
53	Male	49	624	4	2.4	5.72	17.3	48.2	25.89	1514.49
54	Female	47	1517	1	0.5	4.3	12.4	37.3	32.05	534.1
55	Female	49	567	1	1	3.72	11.1	32.9	20.17	115.96
56	Female	38	750	2	0.7	4.86	14	41	33.65	944.43
57	Male	53	288	1	1.7	3.97	13.5	40.3	23.67	502.85
58	Male	38	1032	2	1.4	4.22	12	36.1	22.23	64.29
59	Male	60	5	1	1.9	4.01	99	29.7	20.31	712.41
60	Female	57	340	1	1.67	3.63	11	31.6	19.03	996.97
61	Male	46	510	1	7	3.48	9.8	29.3	21.87	287.12
62	Male	60	770	2	1.1	4.62	14.7	44.1	26.45	885.28
63	Male	53	1836	2	1.1	5.23	15.6	44.9	27.76	972.21
64	Female	57	2400	1	0.9	3.66	10.7	32.9	34.23	37.55
65	Female	47	1659	2	1.9	3.66	11.7	36.2	24.97	714.46
66	Female	57	1170	1	0.7	4.96	13.2	40.6	24.3	20.24
67	Male	53	140	1	1.3	4.45	13.4	38.2	22.86	531.95
68	Male	48	644	4	0.8	5.09	14.4	41.8	22.77	700.6
69	Female	56	288	2	1.5	4.02	11.5	36.4	33.78	1407.38
70	Male	57	540	1	1.7	5.04	13.8	41.9	23.83	925.04
71	Female	38	108	1	0.8	4.43	13.4	38.4	20.57	177.36
72	Female	80	520	3	0.7	4.33	11.8	35.5	17.71	423.1
73	Female	53	249	3	0.9	3.51	9.5	29.3	20.03	375.78
74	Male	41	646	1	1	4.68	13.5	41.7	26.64	325.61
75	Female	41	880	1	0.9	4.71	13.6	39.9	27.99	965.05
76	Female	46	200	2	0.9	3.61	10.7	33.2	28.04	145.36
77	Male	64	300	1	2	4.1	14.1	41.6	23.44	421.38
78	Male	50	234	1	1.2	4.32	13.7	40.2	23.03	238.03
79	Male	55	2340	1	3.7	2.79	8.6	25.4	22.6	31.2
80	Male	56	350	1	1.9	4.85	14.2	40.6	21.26	511.47
81	Male	39	294	1	0.9	4.89	16.4	47.9	22.04	554.72
82	Male	32	300	1	1.6	4.96	14.8	43.9	23.12	687.55
83	Female	54	2900	2	0.9	4.02	10.9	32.9	16.18	608.33
84	Male	69	804	2	1.27	4.76	15.5	46.1	21.08	677.1

Dataset 1.Raw data for Table 3 of 'Blood loss predictive factors and transfusion practice during percutaneous nephrolithotomy of kidney stones'.

The raw data of the bivariate analysis between related factors and total blood loss are provided.

Patient Number	Intra-operative transfusion	Post-operative transfusion	Amount of Blood Unit Cross-matched (ml)	Amount of Blood Transfused peri-operative (ml)	Total Blood Loss (ml)
1	No	No	500	0	0
2	Yes	No	500	350	1559.49
3	No	No	500	0	1246.8
4	No	No	500	0	441.37
5	No	No	500	0	148.13
6	No	Yes	500	300	1320.32
7	No	No	500	0	605.02
8	No	No	300	0	845.46
9	No	No	300	0	696.46
10	No	No	300	0	301.8
11	No	No	300	0	221.44
12	Yes	Yes	500	632	1635.48
13	No	No	300	0	685.21
14	Yes	Yes	300	532	1974.84
15	No	No	300	0	182.66
16	No	No	300	0	0
17	No	No	500	0	228.88
18	No	No	300	0	164.22
19	No	No	300	0	1321.48
20	No	No	1000	0	434.29
21	No	No	500	0	175.53
22	No	No	300	0	303.03
23	No	No	500	0	55.41
24	No	Yes	500	400	626.09
25	No	No	300	0	520.98
26	No	No	500	0	608.33
27	No	No	500	0	682.37
28	No	No	500	0	353.21
29	No	No	500	0	547.86
30	No	No	300	0	46.5
31	No	No	300	0	630.93
32	No	No	500	0	313.03
33	No	Yes	500	300	867.66
34	No	No	500	0	214.87
35	No	No	500	0	146.84
36	No	No	500	0	79.6
37	No	No	500	0	396.96
38	No	No	500	0	307.66
39	No	No	500	0	873.87
40	No	No	500	0	88.7
41	No	No	300	0	186.34
42	No	No	500	0	234.05
43	Yes	No	500	200	1052.83
44	No	No	500	0	521.63
45	No	No	500	0	653.29
46	No	No	500	0	441.55
47	No	No	300	0	0
48	No	Yes	500	300	636.86
49	No	No	500	0	1106.5
50	No	No	300	0	903.85
51	No	No	500	0	415.85
52	No	No	300	0	491.93
53	No	No	500	0	1514.49
54	No	Yes	500	225	534.1
55	No	No	500	0	115.96
56	No	No	300	0	944.43
57	No	No	500	0	502.85
58	Yes	No	500	177	64.29
59	No	No	500	0	712.41
60	No	Yes	500	500	996.97
61	No	No	500	0	287.12
62	No	No	500	0	885.28
63	No	No	500	0	972.21
64	No	No	500	0	37.55
65	No	No	500	0	714.46
66	No	No	300	0	20.24
67	No	No	300	0	531.95
68	No	No	500	0	700.6
69	No	No	300	0	1407.38
70	No	No	300	0	925.04
71	No	No	500	0	177.36
72	No	No	500	0	423.1
73	No	No	500	0	375.78
74	No	No	300	0	325.61
75	No	No	300	0	965.05
76	No	No	500	0	145.36
77	No	No	500	0	421.38
78	No	No	300	0	238.03
79	No	No	300	0	31.2
80	No	No	300	0	511.47
81	No	No	300	0	554.72
82	No	No	300	0	687.55
83	No	No	500	0	608.33
84	No	No	500	0	677.1

Dataset 2.Raw data for Table 4 of 'Blood loss predictive factors and transfusion practice during percutaneous nephrolithotomy of kidney stones'.

The raw data for ‘Blood transfusion practice’ are provided.

Discussion

In this study we did not use conventional, visual estimated blood loss to determine hemorrhage due to high bias factors, subjectivity, persistence of dilution effect and poor accuracy^19–23. Laboratory parameters in our study were recorded until 72-hours post-operatively, in order to minimize intravenous hydration and retroperitoneal fluid absorption effects. We used the hematocrit level as the main parameter to determine blood loss rather than hemoglobin to avoid hemodilution effect^15,24; Furthermore, the hematocrit level positively correlated with the total blood volume²⁵. It has been reported that also a center in Turkey applies a blood transfusion policy that depends on the hematocrit level (transfusion was indicated when hematocrit level was less than 30%)¹⁴.

Stone burden was the most influential predictive factor for blood loss during the PCNL procedure in this study, similar to other studies performed. A multivariate analysis showed that complete and partial staghorn calculi were associated with a greater blood loss than with the calyx stones¹⁴. Other studies concluded that larger stone burdens¹¹ or staghorn calculi²⁶ required a greater amount of unit blood transfused during the PCNL procedure compared to the smaller stones. Greater hematocrit level changes in staghorn calculi were found during PCNL, while further multivariate tests concluded that staghorn calculi were associated with a greater amount of blood loss (OR 1.92) and a greater decrease in the hemoglobin level compared to non-staghorn cases¹³. Prolonged and excessive intra-renal maneuver performed for large stone burdens was assumed to increase incidence of injury to renal vasculature¹¹.

Our transfusion rate was similar to the one reported in a retrospective study from Pakistan showing an overall blood transfusion rate of 14.2% with one angioembolization performed to control hemorrhage²⁶. In our study, all cases presenting with massive hemorrhage could be managed conservatively. Lower blood transfusion rates were reported in two other studies from Pakistan, one study from United Kingdom and one study from the United States; these differences occurred due to the younger age group²⁷, supine position used²⁸ and balloon dilatation^29,30. A higher transfusion rate (23.8%) compared to our result was shown in a retrospective analysis. An aggressive approach by torqueing the rigid nephroscope to maximize stone clearance at one stage was explained¹⁴.

A precise estimation of surgical blood loss is essential in order to avoid excessive usage of blood units. Most of the previous studies emphasize the estimated blood loss rather than the objective prediction. Our calculation of total blood loss included perioperative factors: the patient’s blood volume (based on sex, body weight and height), the number of red cell units transfused, the hematocrit changes, and the amount of hemodilution. To our knowledge, this is the first study that has applied a mathematical approach to predict blood loss during PCNL procedures. We did not include hydronephrosis grading, parenchymal thickness and stone composition to analyze the predictive factors of blood loss, due to the possible limitations relating to our study.

Conclusions

Stone burden was the most influential PCNL blood loss predictive factor in our institution. We estimated that the amount of blood requested and cross-matched for PCNL is much greater than the actual blood loss. Our principle was proposed as a guidance to reduce any unnecessary costs and excessive requirements of blood units.

Consent

Written informed consent to participate in the study and publish clinical data was obtained by the patients.

Data availability

F1000Research: Dataset 1. Raw data for Table 3 of 'Blood loss predictive factors and transfusion practice during percutaneous nephrolithotomy of kidney stones', 10.5256/f1000research.8993.d127629³¹

F1000Research: Dataset 2. Raw data for Table 4 of 'Blood loss predictive factors and transfusion practice during percutaneous nephrolithotomy of kidney stones', 10.5256/f1000research.8993.d127630³²

Author contributions

FAS - study concepts, design of study, data acquisition, data interpretation, statistical analysis, manuscript preparation. PB - study concepts, design of study, manuscript review, funds collection. NR - design of study, manuscript review, funds collection. FAM - literature research, data acquisition. EN - manuscript editing. MHH - manuscript editing. All authors have agreed to publish this final manuscript.

Competing interests

No competing interests were disclosed.

Grant information

Cipto Mangunkusumo Hospital Operational Research Grant 2013 funded this research.

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

F1000 recommended

References

1. Saigal CS, Joyce G, Timilsina AR, et al.: Direct and indirect costs of nephrolithiasis in an employed population: opportunity for disease management? Kidney Int. 2005; 68(4): 1808–14. PubMed Abstract | Publisher Full Text
2. Hesse A, Brändle E, Wilbert D, et al.: Study on the prevalence and incidence of urolithiasis in Germany comparing the years 1979 vs. 2000. Eur Urol. 2003; 44(6): 709–13. PubMed Abstract | Publisher Full Text
3. Yasui T, Iguchi M, Suzuki S, et al.: Prevalence and epidemiological characteristics of urolithiasis in Japan: national trends between 1965 and 2005. Urology. 2008; 71(2): 209–13. PubMed Abstract | Publisher Full Text
4. Romero V, Akpinar H, Assimos DG: Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol. 2010; 12(2–3): e86–96. PubMed Abstract | Free Full Text
5. Rahardjo D: Perkembangan penatalaksanaan batu ginjal di RSCM tahun 1997–2002. J I Bedah Indones. 2004; 32: 58–63.
6. Gupta M, Ost M, Shah J, et al.: Percutaneous management of the upper urinary tract. In Wein A, Novick A and Peters C: Campbell's urology. Philadelphia, W.B. Saunders Co, 2007; 1526–1563.
7. Skolarikos A, Alivizatos G, de la Rosette JJ: Percutaneous nephrolithotomy and its legacy. Eur Urol. 2005; 47(1): 22–8. PubMed Abstract | Publisher Full Text
8. Türk C, Knoll T, Petrik A, et al.: Guidelines on Urolithiasis.2013; 5: 19–40. Reference Source
9. Preminger GM, Assimos DG, Lingeman JE, et al.: Chapter 1: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol. 2005; 173(6): 1991–2000. PubMed Abstract | Publisher Full Text
10. Birowo P, Rasyid N: Sekilas perjalanan hidup dr. Rochani, Sp.B, Sp.U(K). In Birowo P: Purna bakti dr. Rochani, Sp.B, Sp.U(K). Jakarta, Divisi Urologi Departemen Ilmu Bedah FKUI/Departemen Urologi RSCM, 2010.
11. Kukreja R, Desai M, Patel S, et al.: Factors affecting blood loss during percutaneous nephrolithotomy: prospective study. J Endourol. 2004; 18(8): 715–22. PubMed Abstract | Publisher Full Text
12. Keoghane SR, Cetti RJ, Rogers AE, et al.: Blood transfusion, embolisation and nephrectomy after percutaneous nephrolithotomy (PCNL). BJU Int. 2013; 111(4): 628–32. PubMed Abstract | Publisher Full Text
13. Akman T, Binbay M, Sari E, et al.: Factors affecting bleeding during percutaneous nephrolithotomy: single surgeon experience. J Endourol. 2011; 25(2): 327–33. PubMed Abstract | Publisher Full Text
14. Turna B, Nazli O, Demiryoguran S, et al.: Percutaneous nephrolithotomy: variables that influence hemorrhage. Urology. 2007; 69(4): 603–7. PubMed Abstract | Publisher Full Text
15. Rosencher N, Kerkkamp HE, Macheras G, et al.: Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe. Transfusion. 2003; 43(4): 459–69. PubMed Abstract | Publisher Full Text
16. Hurle R, Poma R, Maffezzini M, et al.: A simple mathematical approach to calculate blood loss in radical prostatectomy. Urol Int. 2004; 72(2): 135–9. PubMed Abstract | Publisher Full Text
17. Khan FA, Khan M, Ali A, et al.: Estimation of blood loss during Caesarean section: an audit. J Pak Med Assoc. 2006; 56(12): 572–5. PubMed Abstract
18. Seruya M, Oh AK, Rogers GF, et al.: Blood loss estimation during fronto-orbital advancement: implications for blood transfusion practice and hospital length of stay. J Craniofac Surg. 2012; 23(5): 1314–7. PubMed Abstract | Publisher Full Text
19. Poletajew S, Antoniewicz AA: Blood loss during laparoscopic radical prostatectomy - is it significant or not? Cent European J Urol. 2012; 65(1): 11–13. PubMed Abstract | Publisher Full Text
20. McCullough TC, Roth JV, Ginsberg PC, et al.: Estimated blood loss underestimates calculated blood loss during radical retropubic prostatectomy. Urol Int. 2004; 72(1): 13–16. PubMed Abstract | Publisher Full Text
21. Stafford I, Dildy GA, Clark SL, et al.: Visually estimated and calculated blood loss in vaginal and cesarean delivery. Am J Obstet Gynecol. 2008; 199(5): 519.e1–7. PubMed Abstract | Publisher Full Text
22. Gharoro EP, Enabudoso EJ: Relationship between visually estimated blood loss at delivery and postpartum change in haematocrit. J Obstet Gynaecol. 2009; 29(6): 517–520. PubMed Abstract | Publisher Full Text
23. Schorn MN: Measurement of blood loss: review of the literature. J Midwifery Womens Health. 2010; 55(1): 20–27. PubMed Abstract | Publisher Full Text
24. Kukreja R, Desai M, Patel S, et al.: Factors affecting blood loss during percutaneous nephrolithotomy: prospective study. J Endourol. 2004; 18(8): 715–722. PubMed Abstract | Publisher Full Text
25. Turna B, Nazli O, Demiryoguran S, et al.: Percutaneous nephrolithotomy: variables that influence hemorrhage. Urology. 2007; 69(4): 603–607. PubMed Abstract | Publisher Full Text
26. Zehri AA, Biyabani SR, Siddiqui KM, et al.: Triggers of blood transfusion in percutaneous nephrolithotomy. J Coll Physicians Surg Pak. 2011; 21(3): 138–41. PubMed Abstract
27. Mahmud M, Zaidi Z: Percutaneous nephrolithotomy in children before school age: experience of a Pakistani centre. BJU Int. 2004; 94(9): 1352–4. PubMed Abstract | Publisher Full Text
28. Rana AM, Bhojwani JP, Junejo NN, et al.: Tubeless PCNL with patient in supine position: procedure for all seasons?--with comprehensive technique. Urology. 2008; 71(4): 581–5. PubMed Abstract | Publisher Full Text
29. Armitage JN, Irving SO, Burgess NA, et al.: Percutaneous nephrolithotomy in the United kingdom: results of a prospective data registry. Eur Urol. 2012; 61(6): 1188–93. PubMed Abstract | Publisher Full Text
30. Tomaszewski JJ, Smaldone MC, Schuster T, et al.: Factors affecting blood loss during percutaneous nephrolithotomy using balloon dilation in a large contemporary series. J Endourol. 2010; 24(2): 207–11. PubMed Abstract | Publisher Full Text
31. Syahputra FA, Birowo P, Rasyid N, et al.: Dataset 1 in: Blood loss predictive factors and transfusion practice during percutaneous nephrolithotomy of kidney stones: a prospective study. F1000Research. 2016. Data Source
32. Syahputra FA, Birowo P, Rasyid N, et al.: Dataset 2 in: Blood loss predictive factors and transfusion practice during percutaneous nephrolithotomy of kidney stones: a prospective study. F1000Research. 2016. Data Source

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¹ Department of Urology, Cipto Mangunkusumo Hospital, faculty of Medicine, Jakarta, 10430, Indonesia

Competing interests

No competing interests were disclosed.

Grant information

Cipto Mangunkusumo Hospital Operational Research Grant 2013 funded this research.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Published: 30 Jun 2016, 5:1550

https://doi.org/10.12688/f1000research.8993.1

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© 2016 Syahputra FA et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Data associated with the article are available under the terms of the Creative Commons Zero "No rights reserved" data waiver (CC0 1.0 Public domain dedication).

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Syahputra FA, Birowo P, Rasyid N et al. Blood loss predictive factors and transfusion practice during percutaneous nephrolithotomy of kidney stones: a prospective study [version 1; peer review: 1 approved, 2 approved with reservations]. F1000Research 2016, 5:1550 (https://doi.org/10.12688/f1000research.8993.1)

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ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested

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Reviewer Report 12 Jul 2016

Doddy Musbadianto Soebadi, Department of Urology, Airlangga University, Surabaya, Indonesia

Approved

https://doi.org/10.5256/f1000research.9674.r14725

This is a nice article concerning blood loss during percutaneous nephrolithotomy (PCNL) procedures. We need these data to confirm that this ... Continue reading

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Reviewer Report 11 Jul 2016

Manint Usawachintachit, Department of Urology, University of California San Francisco, San Francisco, CA, USA; Division of Urology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand

Approved with Reservations

https://doi.org/10.5256/f1000research.9674.r14722

The authors present a study looking for predictive factor of blood loss following PCNL from a single institution for 85 patients over a 1-year period. It’s interesting data in that while most relevant published studies were carried out retrospectively, this ... Continue reading

The authors present a study looking for predictive factor of blood loss following PCNL from a single institution for 85 patients over a 1-year period. It’s interesting data in that while most relevant published studies were carried out retrospectively, this study is prospective. The primary endpoints were changes in hematocrit level and blood transfusion requirement over an early postoperative period.

Overall, the paper was written concisely with a good methodology to track blood loss level. I would recommend some revision enumerated below:

General comments

Besides grammatical errors, there are some misspelled words.

Abstract

In the Result, a percentage of intra and postoperative transfusion should be 2.3%, not 23%.
It may be helpful to add a conclusion to the abstract.

Introduction

No specific comments.

Material and Methods

Were all patients included in this study consecutively?
How was stone burden assessed by means of imaging? Was it measured from CT-scan, plain film, or IVP?
How was a hematocrit level measured? Was it from a full blood draw or just fingertip needle sticks crude measurement?
What was an algorithm of decision for perioperative blood transfusion in this study? Did the authors make a judgement based on a “specific” cutoff point of the most recent blood count (at 12, 24, 36, and 72 hours after PCNL) or make a decision subjectively? There should be a systematic methodology in this issue because it significantly affected transfusion rate and volume.

Results

How many patients were excluded from this study because of a conversion to open procedure? Were they converted from profound intraoperative bleeding?
What were a mean BMI of patients, and distribution of hydronephrosis in this series? The authors have mentioned in the Introduction that they were risk factors for blood transfusion flowing PCNL.
What was a distribution of renal access (upper/middle/lower/multi-tract) in this study? Did number of renal access tract affect blood loss or transfusion rate?
In a multivariate analysis of variables and blood loss, was stone burden (p = 0.037) the only one factor that remained statistically significant? This data was not shown in Table 3. What were other variables included in the multivariate analysis and why did the authors include operative time (p > 0.05) in this model?

Discussion

The authors mentioned a hematocrit cut-point of 30% from a Turkish study. Did the authors use the same cut-point for transfusion in this study?
Transfusion rate in this series was relatively high (12.9%) and the authors have demonstrated a significant correlation between stone burden and blood loss. Could this high transfusion rate cause by a larger stone burden? This data (mean stone burden) was not shown in the manuscript.
What is a clinical benefit of the mathematical equation to predict blood loss preoperatively? Could we use it to obviate blood request in some patients?

Miscellaneous

In Table 2, it may be more understandable to order presenting symptoms by percentages.
In Dataset 1, why did the authors perform PCNL in some stones of 5 mm² size. Is it more reasonable to treat them with ESWL or flexible ureteroscopy.

Competing Interests: No competing interests were disclosed.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Reviewer Report 30 Jun 2016

M. Hammad Ather, Section of Urology, Aga khan University, Karachi, Pakistan

Approved with Reservations

https://doi.org/10.5256/f1000research.9674.r14721

Authors have assessed the predictive value of various parameters for transfusion during / following PCNL. It is an important area as bleeding and need for transfusion is still a major concern during PCNL. I read with interest the fact that ... Continue reading

Authors have assessed the predictive value of various parameters for transfusion during / following PCNL. It is an important area as bleeding and need for transfusion is still a major concern during PCNL. I read with interest the fact that the authors have performed all procedures under spinal anesthesia. Although it is feasible and has been reported in literature it is both cumbersome for patients, anesthetist and surgeon to perform this procedure in an awake patient. In addition to maintain level of spinal anesthesia to provide pain free procedure and yet not compromising ventilation in a spontaneously breathing patient is a difficult task. It is not clear from the methods described if the procedure was performed in prone or supine position. In the methods section authors have noted that "the procedure was randomly performed.....", I am not sure as to what the authors intended to mean. In addition in the methods section authors have noted that the "The procedure was completed when the patient was stone-free and any arising complications alleviated. " the meaning of this sentence is also not clear. In the results section authors have noted that "statistical power of 0.8 ", kindly clarify the sentence.

Authors noted stone burden as clinical (statistically significant) factor in predicting need for transfusion. This is conformed by many previous studies and authors conclusion does not surprise me.

In recent years many scoring systems have been developed to predict complexity of the procedure and stone free rate like STONE nephrolithomeetry score, Guys score etc. Authors should comment why they decided to use stone burden rather than these scores in predicting complexity level of the procedure and predicting need for transfusion.

A recent report by Un et al., 2015¹ noted transfusion requirement of ~10% and need for embolization in <1% in over 1400 PCNL over a 7 years period.

References

1. Un S, Cakir V, Kara C, Turk H, et al.: Risk factors for hemorrhage requiring embolization after percutaneous nephrolithotomy.Can Urol Assoc J. 9 (9-10): E594-8 PubMed Abstract | Publisher Full Text

Competing Interests: No competing interests were disclosed.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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M. Hammad Ather, Aga khan University, Karachi, Pakistan
Manint Usawachintachit, University of California San Francisco, San Francisco, USA; Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
Doddy Musbadianto Soebadi, Airlangga University, Surabaya, Indonesia

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12 Jul 2016 | for Version 1

Doddy Musbadianto Soebadi, Department of Urology, Airlangga University, Surabaya, Indonesia

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Approved

This is a nice article concerning blood loss during percutaneous nephrolithotomy (PCNL) procedures. We need these data to confirm that this procedure is safe to be done in a proper way.

The authors have meticulously analyzed and discussed the results.

Competing Interests

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I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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11 Jul 2016 | for Version 1

Manint Usawachintachit, Department of Urology, University of California San Francisco, San Francisco, CA, USA; Division of Urology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand

19 Views Cite this report Responses(0)

Approved With Reservations

The authors present a study looking for predictive factor of blood loss following PCNL from a single institution for 85 patients over a 1-year period. It’s interesting data in that while most relevant published studies were carried out retrospectively, this study is prospective. The primary endpoints were changes in hematocrit level and blood transfusion requirement over an early postoperative period.

Overall, the paper was written concisely with a good methodology to track blood loss level. I would recommend some revision enumerated below:

General comments

Besides grammatical errors, there are some misspelled words.

Abstract

In the Result, a percentage of intra and postoperative transfusion should be 2.3%, not 23%.
It may be helpful to add a conclusion to the abstract.

Introduction

No specific comments.

Material and Methods

Were all patients included in this study consecutively?
How was stone burden assessed by means of imaging? Was it measured from CT-scan, plain film, or IVP?
How was a hematocrit level measured? Was it from a full blood draw or just fingertip needle sticks crude measurement?
What was an algorithm of decision for perioperative blood transfusion in this study? Did the authors make a judgement based on a “specific” cutoff point of the most recent blood count (at 12, 24, 36, and 72 hours after PCNL) or make a decision subjectively? There should be a systematic methodology in this issue because it significantly affected transfusion rate and volume.

Results

How many patients were excluded from this study because of a conversion to open procedure? Were they converted from profound intraoperative bleeding?
What were a mean BMI of patients, and distribution of hydronephrosis in this series? The authors have mentioned in the Introduction that they were risk factors for blood transfusion flowing PCNL.
What was a distribution of renal access (upper/middle/lower/multi-tract) in this study? Did number of renal access tract affect blood loss or transfusion rate?
In a multivariate analysis of variables and blood loss, was stone burden (p = 0.037) the only one factor that remained statistically significant? This data was not shown in Table 3. What were other variables included in the multivariate analysis and why did the authors include operative time (p > 0.05) in this model?

Discussion

The authors mentioned a hematocrit cut-point of 30% from a Turkish study. Did the authors use the same cut-point for transfusion in this study?
Transfusion rate in this series was relatively high (12.9%) and the authors have demonstrated a significant correlation between stone burden and blood loss. Could this high transfusion rate cause by a larger stone burden? This data (mean stone burden) was not shown in the manuscript.
What is a clinical benefit of the mathematical equation to predict blood loss preoperatively? Could we use it to obviate blood request in some patients?

Miscellaneous

In Table 2, it may be more understandable to order presenting symptoms by percentages.
In Dataset 1, why did the authors perform PCNL in some stones of 5 mm² size. Is it more reasonable to treat them with ESWL or flexible ureteroscopy.

Competing Interests

No competing interests were disclosed.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

Respond to this report

Responses (0)

Back to all reports

Reviewer Report

22 Views

30 Jun 2016 | for Version 1

M. Hammad Ather, Section of Urology, Aga khan University, Karachi, Pakistan

22 Views Cite this report Responses(0)

Approved With Reservations

Authors have assessed the predictive value of various parameters for transfusion during / following PCNL. It is an important area as bleeding and need for transfusion is still a major concern during PCNL. I read with interest the fact that the authors have performed all procedures under spinal anesthesia. Although it is feasible and has been reported in literature it is both cumbersome for patients, anesthetist and surgeon to perform this procedure in an awake patient. In addition to maintain level of spinal anesthesia to provide pain free procedure and yet not compromising ventilation in a spontaneously breathing patient is a difficult task. It is not clear from the methods described if the procedure was performed in prone or supine position. In the methods section authors have noted that "the procedure was randomly performed.....", I am not sure as to what the authors intended to mean. In addition in the methods section authors have noted that the "The procedure was completed when the patient was stone-free and any arising complications alleviated. " the meaning of this sentence is also not clear. In the results section authors have noted that "statistical power of 0.8 ", kindly clarify the sentence.

Authors noted stone burden as clinical (statistically significant) factor in predicting need for transfusion. This is conformed by many previous studies and authors conclusion does not surprise me.

In recent years many scoring systems have been developed to predict complexity of the procedure and stone free rate like STONE nephrolithomeetry score, Guys score etc. Authors should comment why they decided to use stone burden rather than these scores in predicting complexity level of the procedure and predicting need for transfusion.

A recent report by Un et al., 2015¹ noted transfusion requirement of ~10% and need for embolization in <1% in over 1400 PCNL over a 7 years period.

References

1. Un S, Cakir V, Kara C, Turk H, et al.: Risk factors for hemorrhage requiring embolization after percutaneous nephrolithotomy.Can Urol Assoc J. 9 (9-10): E594-8 PubMed Abstract | Publisher Full Text

Competing Interests

No competing interests were disclosed.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

Respond to this report

Responses (0)

[1] 1. Saigal CS, Joyce G, Timilsina AR, et al.: Direct and indirect costs of nephrolithiasis in an employed population: opportunity for disease management? Kidney Int. 2005; 68(4): 1808–14. PubMed Abstract | Publisher Full Text

[2] 2. Hesse A, Brändle E, Wilbert D, et al.: Study on the prevalence and incidence of urolithiasis in Germany comparing the years 1979 vs. 2000. Eur Urol. 2003; 44(6): 709–13. PubMed Abstract | Publisher Full Text

[3] 3. Yasui T, Iguchi M, Suzuki S, et al.: Prevalence and epidemiological characteristics of urolithiasis in Japan: national trends between 1965 and 2005. Urology. 2008; 71(2): 209–13. PubMed Abstract | Publisher Full Text

[4] 4. Romero V, Akpinar H, Assimos DG: Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol. 2010; 12(2–3): e86–96. PubMed Abstract | Free Full Text

[5] 5. Rahardjo D: Perkembangan penatalaksanaan batu ginjal di RSCM tahun 1997–2002. J I Bedah Indones. 2004; 32: 58–63.

[6] 6. Gupta M, Ost M, Shah J, et al.: Percutaneous management of the upper urinary tract. In Wein A, Novick A and Peters C: Campbell's urology. Philadelphia, W.B. Saunders Co, 2007; 1526–1563.

[7] 7. Skolarikos A, Alivizatos G, de la Rosette JJ: Percutaneous nephrolithotomy and its legacy. Eur Urol. 2005; 47(1): 22–8. PubMed Abstract | Publisher Full Text

[8] 8. Türk C, Knoll T, Petrik A, et al.: Guidelines on Urolithiasis.2013; 5: 19–40. Reference Source

[9] 9. Preminger GM, Assimos DG, Lingeman JE, et al.: Chapter 1: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol. 2005; 173(6): 1991–2000. PubMed Abstract | Publisher Full Text

[10] 10. Birowo P, Rasyid N: Sekilas perjalanan hidup dr. Rochani, Sp.B, Sp.U(K). In Birowo P: Purna bakti dr. Rochani, Sp.B, Sp.U(K). Jakarta, Divisi Urologi Departemen Ilmu Bedah FKUI/Departemen Urologi RSCM, 2010.

[11] 11. Kukreja R, Desai M, Patel S, et al.: Factors affecting blood loss during percutaneous nephrolithotomy: prospective study. J Endourol. 2004; 18(8): 715–22. PubMed Abstract | Publisher Full Text

[12] 12. Keoghane SR, Cetti RJ, Rogers AE, et al.: Blood transfusion, embolisation and nephrectomy after percutaneous nephrolithotomy (PCNL). BJU Int. 2013; 111(4): 628–32. PubMed Abstract | Publisher Full Text

[13] 13. Akman T, Binbay M, Sari E, et al.: Factors affecting bleeding during percutaneous nephrolithotomy: single surgeon experience. J Endourol. 2011; 25(2): 327–33. PubMed Abstract | Publisher Full Text

[14] 14. Turna B, Nazli O, Demiryoguran S, et al.: Percutaneous nephrolithotomy: variables that influence hemorrhage. Urology. 2007; 69(4): 603–7. PubMed Abstract | Publisher Full Text

[15] 15. Rosencher N, Kerkkamp HE, Macheras G, et al.: Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe. Transfusion. 2003; 43(4): 459–69. PubMed Abstract | Publisher Full Text

[16] 16. Hurle R, Poma R, Maffezzini M, et al.: A simple mathematical approach to calculate blood loss in radical prostatectomy. Urol Int. 2004; 72(2): 135–9. PubMed Abstract | Publisher Full Text

[17] 17. Khan FA, Khan M, Ali A, et al.: Estimation of blood loss during Caesarean section: an audit. J Pak Med Assoc. 2006; 56(12): 572–5. PubMed Abstract

[18] 18. Seruya M, Oh AK, Rogers GF, et al.: Blood loss estimation during fronto-orbital advancement: implications for blood transfusion practice and hospital length of stay. J Craniofac Surg. 2012; 23(5): 1314–7. PubMed Abstract | Publisher Full Text

[19] 19. Poletajew S, Antoniewicz AA: Blood loss during laparoscopic radical prostatectomy - is it significant or not? Cent European J Urol. 2012; 65(1): 11–13. PubMed Abstract | Publisher Full Text

[20] 20. McCullough TC, Roth JV, Ginsberg PC, et al.: Estimated blood loss underestimates calculated blood loss during radical retropubic prostatectomy. Urol Int. 2004; 72(1): 13–16. PubMed Abstract | Publisher Full Text

[21] 21. Stafford I, Dildy GA, Clark SL, et al.: Visually estimated and calculated blood loss in vaginal and cesarean delivery. Am J Obstet Gynecol. 2008; 199(5): 519.e1–7. PubMed Abstract | Publisher Full Text

[22] 22. Gharoro EP, Enabudoso EJ: Relationship between visually estimated blood loss at delivery and postpartum change in haematocrit. J Obstet Gynaecol. 2009; 29(6): 517–520. PubMed Abstract | Publisher Full Text

[23] 23. Schorn MN: Measurement of blood loss: review of the literature. J Midwifery Womens Health. 2010; 55(1): 20–27. PubMed Abstract | Publisher Full Text

[24] 24. Kukreja R, Desai M, Patel S, et al.: Factors affecting blood loss during percutaneous nephrolithotomy: prospective study. J Endourol. 2004; 18(8): 715–722. PubMed Abstract | Publisher Full Text

[25] 25. Turna B, Nazli O, Demiryoguran S, et al.: Percutaneous nephrolithotomy: variables that influence hemorrhage. Urology. 2007; 69(4): 603–607. PubMed Abstract | Publisher Full Text

[26] 26. Zehri AA, Biyabani SR, Siddiqui KM, et al.: Triggers of blood transfusion in percutaneous nephrolithotomy. J Coll Physicians Surg Pak. 2011; 21(3): 138–41. PubMed Abstract

[27] 27. Mahmud M, Zaidi Z: Percutaneous nephrolithotomy in children before school age: experience of a Pakistani centre. BJU Int. 2004; 94(9): 1352–4. PubMed Abstract | Publisher Full Text

[28] 28. Rana AM, Bhojwani JP, Junejo NN, et al.: Tubeless PCNL with patient in supine position: procedure for all seasons?--with comprehensive technique. Urology. 2008; 71(4): 581–5. PubMed Abstract | Publisher Full Text

[29] 29. Armitage JN, Irving SO, Burgess NA, et al.: Percutaneous nephrolithotomy in the United kingdom: results of a prospective data registry. Eur Urol. 2012; 61(6): 1188–93. PubMed Abstract | Publisher Full Text

[30] 30. Tomaszewski JJ, Smaldone MC, Schuster T, et al.: Factors affecting blood loss during percutaneous nephrolithotomy using balloon dilation in a large contemporary series. J Endourol. 2010; 24(2): 207–11. PubMed Abstract | Publisher Full Text

[31] 31. Syahputra FA, Birowo P, Rasyid N, et al.: Dataset 1 in: Blood loss predictive factors and transfusion practice during percutaneous nephrolithotomy of kidney stones: a prospective study. F1000Research. 2016. Data Source

[32] 32. Syahputra FA, Birowo P, Rasyid N, et al.: Dataset 2 in: Blood loss predictive factors and transfusion practice during percutaneous nephrolithotomy of kidney stones: a prospective study. F1000Research. 2016. Data Source

Blood loss predictive factors and transfusion practice during percutaneous nephrolithotomy of kidney stones: a prospective study

Abstract

Keywords

Introduction

Materials and methods

Table 1. Operational definition.

Results

Table 2. Patient Characteristics (n=85).

Table 3. Bivariate analysis between related factors and total blood loss.

Table 4. Blood transfusion pattern.

Discussion

Conclusions

Consent

Data availability

Author contributions

Competing interests

Grant information

References

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