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WCE 2019: Investigating the Role of Smaller Tract Percutaneous Nephrolithotomy in the Fully Anticoagulated Patient

Abu Dhabi, United Arab Emirates (UroToday.com) Anticoagulation is a contradiction to percutaneous nephrolithotomy (PCNL) as it increases the risk of bleeding. Furthermore, high-risk patients who stop anticoagulation before surgery are at increased risk of fatal cardiovascular events. However, as smaller tract surgery (defined as access tract of 14-22Fr) with mini-PCNL is gaining popularity in the United States, the risk of bleeding may be mitigated by a significant decrease in tract size.  Mini-PCNL tract size results in significantly less renal parenchymal trauma as compared to a standard 30Fr tract. It has also demonstrated decreased blood transfusion rates as compared to standard PCNL rates.

Dr. Meagan Dunne and her colleagues sought to report the surgical outcomes of 10 patients on anticoagulation who underwent mini-PCNL and to determine if mini-PCNL is feasible for these patients. These 10 patients had their surgeries performed between 2018 and 2019. All operations were performed by 2 surgeons in a hospital setting. Tract size was 17Fr and renal access was obtained by the operating surgeon. Patients were on apixaban, rivaroxaban, warfarin, or clopidogrel. No intraoperative complications related to bleeding were noted and no patients required blood transfusions. On postoperative day 1, there was a mean hemoglobin change of 1.24g/dl. One patient had a small hematoma on postoperative day 1. 

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In conclusion, mini-PCNL can be cautiously considered in select high-risk patients on full anticoagulation.

Presented by: Meagan M. Dunne, MD, University of Maryland Medical Center, Chesapeake Urology and University of Maryland BWMC

Written by: Lillian Xie, BA, Department of Urology, University of California, Irvine, California, at the 37th World Congress of Endourology (WCE) – October 29th-November 2nd, Abu Dhabi, United Arab Emirates