Monopolar electrocautery in providing hemostasis of the percutaneous tract during tubeless miniature percutaneous nephrolithotomy

Abstract

Introduction: Kidney hemorrhage is one of the most common and significant complications of percutaneous approaches for renal stone removal. This study evaluated the effectiveness and safety of hemostatic completion in minimally invasive percutaneous nephrolithotomy (mini-PCNL) using monopolar electrocautery in patients with intrarenal tract bleeding. Materials and methods: We prospectively investigated 200 consecutive patients presenting to a single institution and classified them into two groups. The experimental group consisted of 28 patients receiving monopolar coagulation for intrarenal bleeders in the percutaneous tract. The control group included 172 patients in whom fulguration was not done. Perioperative outcomes were compared between the groups. Results: The two groups had no statistical difference in operative times and transfusion rates. Patients who received electrocauterization demonstrated a significantly shortened duration of double J stent removal (p = 0.011), more rapid recovery of hemoglobin levels, particularly in cases of significant bleeding (p < 0.001), and a lower rate of angiography (p = 0.047). No embolization was needed in the electrocauterization group. No significant complications were observed in either group. Conclusions: These findings suggest that monopolar electrocautery might effectively reduce the risk of postoperative bleeding and alleviate the burden on patients who may require additional blood transfusions in patients undergoing tubeless mini-PCNL.