Login to Access Video or Poster Abstract: MP68-10
Sources of Funding: none

Introduction

The rates of heart disease and nephrolithiasis continue to increase in the United States. As more patients on aspirin for secondary prevention present with large kidney stones, urologists are increasingly faced with the decision to proceed with the less effective but lower risk ureteroscopy or the higher risk but more effective percutaneous nephrolithotomy (PCNL). Leavitt, Smith, and Okeke recently published their experience performing PCNLs on seventeen patients continued on aspirin perioperatively and concluded that the procedure was safe. We wish to add our center's experience to this body of knowledge.

Methods

We retrospectively reviewed our single center, single surgeon, experience of 199 PCNLs performed between January 2013 and September 2016. Hemoglobin pre- and post-operatively was recorded as were the relevant related variables of age, sex, BMI, operative duration, skin-to-stone distance, stone size, aspirin dose, aspirin indication, number of blood transfusions, and Clavien-Dindo complication classification. Correlations between hemoglobin and explanatory variables were then explored with linear regression and the Wilcoxon rank-sum test.

Results

Of the 199 PCNLs performed at our institution in the range of our study, 27 procedures on 23 patients were conducted without discontinuing aspirin perioperatively. Coronary artery disease was the most common indication for aspirin use. In 24 cases, the patient was on 81 mg of aspirin perioperatively with the remaining three patients on 325 mg of aspirin daily. The average patient experienced a 1.3 g/dl drop in hemoglobin perioperatively. The largest drop was 4.1 g/dl, but the lowest post-operative hemoglobin was 8.2 g/dl. No significant associations were found between hemoglobin decline and age, sex, BMI, operative duration, skin-to-stone distance, or stone size. There were no Clavien-Dindo grade III or higher complications in the course of our review, and no patients required a blood transfusion or embolization. In one case, a patient required a three day inpatient stay following stent removal for continuous bladder irrigation after developing gross hematuria but this resolved spontaneously.

Conclusions

In our single center experience, PCNLs performed on patients taking aspirin perioperatively were not associated with the need for blood transfusion nor the occurrence of high-grade complications. It is our experience that this practice is safe when performed by expert hands.

Funding

none