Are Routine Laboratory Investigations Necessary Following Percutaneous Nephrolithotomy?

To determine how effective routine post-operative blood work is in identifying complications after percutaneous nephrolithotomy (PCNL), the gold standard treatment for large volume stone disease. Although major complication rates are low, hemorrhagic and sepsis-related complications are serious and can occur. Routine post-PCNL complete blood count (CBC) is routinely performed by most endourologists but may be a low-value practice.

A retrospective review was performed of all PCNL procedures at our center over a 3-year period. Patient demographic, stone characteristics and post-operative data were collected and analyzed.

Three hundred and eighty-five patients (196 female & 189 males) underwent PCNL for the treatment of urolithiasis. Mean age was 55.8 years and mean length of stay in hospital was 1.74 days. Most patients (82.9%) had neither ureteric stent nor percutaneous tube prior to PCNL. Post-operatively, 4 patients (1.0%) required a blood transfusion and 14 patients (3.6%) developed urosepsis. Patients who required either a transfusion or developed urosepsis demonstrated abnormal vital signs (tachycardia, hypotension, or fever) post-operatively. Sixteen patients (4.2%) had normal vital signs but had an extended hospital stay only to monitor abnormal blood work results. None these patients required a transfusion nor developed urosepsis but had a length of stay that was a mean of 1.5 days longer patients with normal post-operative vital signs and blood work.

Abnormal vital signs alone identified all patients that required transfusion or treatment for urosepsis after PCNL. Routine CBC testing post-operatively may not improve detection of infectious or bleeding complications and may prolong hospital admission unnecessarily.

Urology. 2020 May 27 [Epub ahead of print]

Luke F Reynolds, Tadeusz Kroczak, Kenneth T Pace, R John D'A Honey, Michael Ordon, Jason Y Lee

Division of Urology, St. Michael's Hospital, University of Toronto, Toronto, Canada., Division of Urology, St. Michael's Hospital, University of Toronto, Toronto, Canada; Division of Urology, University Health Network, University of Toronto, Toronto, Canada. Electronic address: .