Clinical Efficacy Of Cauterization Of Renal Parenchyma Bleeding Points In Percutaneous Nephrolithotomy With Pluse Cylidrical Electrode: A Randomized Controlled Trial Study

Objective: To perform a perspective randomized controlled study to assess the coagulating efficacy and safety of cauterization of access tract hemorrhagic spots in percutaneous nephrolithotomy with Pluse Cylindrical electrode.Methods: There was not any patient need transarterial embolization to control the hemorrhage. A total of 60 percutaneous nephrolithotomies, which can discover hemorrhagic spots in the access tract, were performed at the department of Urology in Jiangxi Provincial People’s Hospital from July 2013 to December 2014. The patients were divided randomly into the experimental group and the controlled group. In the experimental group(n=30), cauterization of access tract hemorrhagic spots with Pluse Cylindrical electrode was performed. But in the controlled group(n=30), no procession was performed. The drainage fluid for 24 hours from the nephrostomy tube and the catheter was collected continually in three following days after the operation and another 24 hours after remove the nephrostomy tube. And the total amount of hemoglobin in the drainage fluid was evaluated with the method of Cyanide Methemoglobin. The T test method was used on two independent samples to analyze the differences of the amount of bleeding.Results:The average loss of hemoglobin in the experimental group(4.61±0.77g) was significantly lower in the controlled group(7.79±1.82g) during the first 24 h of postoperation. And with significant statistical significance(P<0.01). The average loss of hemoglobin in the experimental group(1.45±0.63g) was significantly lower in the controlled group(3.98±1.74g) from 24 h to 48 h of postoperation. And it was of statistical significance(P<0.05). The average loss of hemoglobin in the experimental group(0.13±0.12g) was lower in the controlled group(0.23±0.47g) from 48 h to 72 h of postoperation. But without significant statistical significance(P>0.05). The average loss of hemoglobin in the experimental group(1.15±0.57g) was significantly lower the controlled group(3.37±1.23g) in the first 24 h after removing the nephrostomy tube, which was also of statistical significance(P<0.05). The totally average loss of hemoglobin in the experimental group(7.34±1.85g) was significantly lower in the controlled group(15.35±4.34g). And with significant statistical significance(P<0.01). In addition, two patients with hematuria after removing the nephrostomy tube in the control group.Conclusions:Cauterization of access tract hemorrhagic spots at the end of percutaneous nephrolithotomy with Pluse Cylindrical electrode decreases the loss of hemoglobin, especially in the first 48 h of postoperation and in the first 24 h after removing the nephrostomy tube, and without causing an increase in morbidity. This procedure is safe and effective and may make more patients suitable for tubeless modification.