Percutaneous nephrolithotomy for liver cirrhosis and upper urinarg calculus patients with coagulation disorders

Objective To investigate the safety and clinical efficacy of percutaneous nephrolithotomy (PCNL) in liver cirrhosis patients complicated with upper urinary tract calculi. Methods Clinical data of 13 patients diagnosed with liver cirrhosis who underwent PCNL from May 2015 to November 2017 in the Department of Urology, Chongqing Peking Sunshine Hospital were retrospectively analyzed. Preoperative and postoperative coagulation function parameters, hemoglobin, stone removal rate and intraoperative and postoperative bleeding were analyzed. Results Among 13 patients, the average operation time was (61±6) min. One patient had residual calculi after surgery and was treated with conservative medication therapy. The stone removal rate was 92.3%(12/13). The average hemoglobin level after surgery was (88.6±5.2) g/L, which was decreased by (14.6±4.8) g/L on average. No severe complications occurred. During perioperative period, 3 patients received blood transfusion. Among them, 1 case received blood transfusion due to severe preoperative anemia, 1 patient was treated by postoperative cryoprecipitate to supplement coagulation factors and 1 case received selective renal artery embolization due to postoperative bleeding. Conclusion PCNL is not an absolute contraindication for liver cirrhosis patients with a high risk of bleeding. PCNL is a relatively safe and efficacious treatment of the upper urinary tract calculi in patients with liver cirrhosis by preoperative regulation and postoperative monitoring of the coagulation function parameters. Key words: Percutaneous nephroscope; Upper urinary tract calculus; Liver cirrhosis; Safety; Retrospective