Do We Really Bleed in Percutaneous Nephrolithotomy? A Single-Surgeon, Single-Center Experience

Percutaneous nephrolithotomy (PCNL) is an effective and guideline-recommended surgical technique for the treatment of large and complex renal stones; however, perioperative bleeding remains one of its most significant complications. Reported bleeding and transfusion rates vary widely in the literature, potentially due to differences in surgical technique, surgeon experience, and institutional practices.

This retrospective, single-center study aims to evaluate perioperative and postoperative bleeding outcomes, transfusion requirements, and bleeding-related complications in patients who underwent PCNL performed by a single surgeon. The findings are intended to clarify whether the real-world bleeding risk associated with PCNL is lower than commonly reported.

Study Overview

• Status: Completed
• Conditions: Urolithiasis
• Intervention / Treatment: Procedure: Percutaneous Nephrolithotomy

Detailed Description

Percutaneous nephrolithotomy (PCNL) is an effective and guideline-recommended surgical technique for the treatment of large and complex renal stones; however, perioperative bleeding remains one of its most significant complications. Reported bleeding and transfusion rates vary widely in the literature, potentially due to differences in surgical technique, surgeon experience, and institutional practices.

This retrospective, single-center study aims to evaluate perioperative and postoperative bleeding outcomes, transfusion requirements, and bleeding-related complications in patients who underwent PCNL performed by a single surgeon. The findings are intended to clarify whether the real-world bleeding risk associated with PCNL is lower than commonly reported. This is a retrospective, single-center observational study conducted at Elazığ Fethi Sekin City Hospital, Türkiye. Medical records of patients who underwent percutaneous nephrolithotomy between August 1, 2022, and December 20, 2025, will be reviewed retrospectively using the hospital information management system and anesthesia records.

All PCNL procedures were performed by a single experienced urologist using standardized surgical techniques. Demographic characteristics, perioperative variables, laboratory values, bleeding parameters, transfusion requirements, postoperative outcomes, and complications will be analyzed. Surgical complications will be classified according to the Clavien-Dindo classification system.

• Study Type: Observational
• Enrollment (Actual): 500

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Elâzığ
    • Elâzığ, Elâzığ, Turkey (Türkiye), 23100
      • Elazığ Fethi Sekin City Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Patients diagnosed with nephrolithiasis who underwent percutaneous nephrolithotomy at a single tertiary care center. The study population consists of adult patients treated by a single surgeon, with perioperative and postoperative outcomes evaluated retrospectively.

Description

Inclusion Criteria:

• Patients who underwent percutaneous nephrolithotomy (PCNL)
• Availability of complete intraoperative and postoperative follow-up data
• Availability of preoperative and postoperative complete blood count and biochemical laboratory results

Exclusion Criteria:

• Pregnancy
• Conversion to open or laparoscopic surgery during PCNL
• Simultaneous additional surgical procedures, bilateral or synchronous bilateral PCNL
• Known coagulation disorders, hematological diseases, or active bleeding in the preoperative period
• Use of anticoagulant or antiplatelet therapy without appropriate perioperative management
• Preoperative blood transfusion requirement
• Severe intraoperative hemodynamic instability affecting the surgical course
• Missing hemoglobin or hematocrit data, insufficient transfusion or complication records
• Inadequate postoperative follow-up or transfer to another institutionConversion to open or laparoscopic surgery during PCNL
• Simultaneous additional surgical procedures, bilateral or synchronous bilateral PCNL
• Known coagulation disorders, hematological diseases, or active bleeding in the preoperative period
• Use of anticoagulant or antiplatelet therapy without appropriate perioperative management
• Preoperative blood transfusion requirement
• Severe intraoperative hemodynamic instability affecting the surgical course
• Missing hemoglobin or hematocrit data, insufficient transfusion or complication records
• Inadequate postoperative follow-up or transfer to another institution

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

Percutaneous Nephrolithotomy (PCNL) Cohort; Patients who underwent percutaneous nephrolithotomy performed by a single surgeon at a single tertiary care center. This retrospective cohort includes patients whose perioperative and postoperative bleeding outcomes, transfusion requirements, and surgical complications were evaluated using existing medical records.

Procedure: Percutaneous Nephrolithotomy; Percutaneous nephrolithotomy performed according to standard clinical practice for the treatment of renal calculi. All procedures were completed by a single experienced surgeon. No additional intervention, modification, or experimental procedure was applied as part of the study. Data related to perioperative and postoperative bleeding outcomes were collected retrospectively from existing medical records.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Hemoglobin Level	The difference between preoperative and postoperative hemoglobin levels (g/dL) will be evaluated in patients undergoing percutaneous nephrolithotomy	From the preoperative baseline to postoperative day 1 and throughout the length of hospital stay.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Hematocrit Level	The change in hematocrit (%) values between the preoperative and postoperative periods will be assessed	From the preoperative baseline to postoperative day 1 and throughout the length of hospital stay.
Estimated Intraoperative Blood Loss	Estimated blood loss (mL) during percutaneous nephrolithotomy will be assessed based on intraoperative surgical records.	During the surgical procedure.
Postoperative Blood Transfusion Requirement	The need for postoperative blood transfusion (yes/no) and the number of transfused packed red blood cell units will be recorded.	From postoperative day 1 until hospital discharge.

Collaborators and Investigators

• Sponsor: Elazıg Fethi Sekin Sehir Hastanesi

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2022
• Primary Completion (Actual): December 20, 2025
• Study Completion (Actual): December 20, 2025

Study Registration Dates

• First Submitted: January 9, 2026
• First Submitted That Met QC Criteria: January 17, 2026
• First Posted (Actual): January 22, 2026

Study Record Updates

• Last Update Posted (Actual): January 22, 2026
• Last Update Submitted That Met QC Criteria: January 17, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: Perkütan Nefrolitotomi; Clavien-Dindo Sınıflandırması; Kan Transfüzyonu
• Additional Relevant MeSH Terms: Urogenital Diseases; Male Urogenital Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urolithiasis; Surgical Procedures, Operative; Minimally Invasive Surgical Procedures; Endoscopy; Urologic Surgical Procedures; Urogenital Surgical Procedures; Laparoscopy; Nephrolithotomy, Percutaneous
• Other Study ID Numbers: FSCH-SB-2025-PCNL

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No