Retrospective analysis of ureteroscopic management of renal calculus disease in patients with coagulopathy secondary to chronic liver disease. – A single centre experience
Keywords:ureteroscopy, chronic liver disease, coagulopathy, thromboelastogram, renal calculi
Objective:Hepatic-coagulopathy is commonly seen in about 70-80% of the patients with chronic liver disease (CLD) and it differs remarkably from other coagulopathies. Urological interventions pose a unique challenge in patients with coagulopathy secondary to CLD. The purpose of this study was to evaluated the safety of ureteroscopic management of renal and ureteric calculi in CLD patients with coagulopathy. Material and Methods:We retrospectively analysed outcome of ureteroscopic procedure (rigid and flexible both) performed in patients with CLD (CLD group, n=13) and in patients without CLD (Non-CLD group, n=39). Similar perioperative protocols were used in both the groups. Prothrombin time (PT) and International Normalized Ratio (INR) were used to rule out coagulopathy in both the groups, however, in CLD group Thromboelastogram (TEG) was done additionally. In the perioperative period, correction of coagulopathy in CLD group was guided by TEG results rather than PT/INR results. Postoperative outcomes of both the groups were compared statistically.ResultsBoth the groups had comparable demographic profile, preoperative haemoglobin levels, platelet counts and stone size. In the CLD group, based on the TEG results, one patient received preoperative platelet transfusion and three patients received preoperative fresh frozen plasma (FFP) transfusion. Post-operative complication rates (15.4% Vs 10.2%, p=0.55), hospital stay (1.46 ± 0.88 days Vs 1.27 ± 0.67 days, p=0.41) and stone free rates (78.4% vs 81.1%, p = 0.77) were comparable in both CLD and Non-CLD groups respectively. Incidence of postoperative haematuria requiring blood transfusion was significantly higher in CLD group (15.4% Vs 0, p=0.01). Conclusion:Ureteroscopic management of renal and ureteric calculi is a safe procedure in CLD patients and its stone free rates are comparable to non CLD patients. However, the risk of bleeding in these patients is significantly higher compared to non-CLD subjects. Perioperative transfusion in CLD patients should be guided by TEG.
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Copyright (c) 2021 Saurabh Jain, Paras Singhal, Shikha Jain, Sridhar P, Deepak Prakash Bhirud, Vikas Jain
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