Risk factors for hemorrhage requiring embolization after percutaneous nephrolithotomy: a meta-analysis

BACKGROUND: The aim of this meta-analysis was to systematically review and identify the risk factors for severe hemorrhage after percutaneous nephrolithotomy (PCNL). METHODS: We searched the PubMed and EMBASE database for literature related to the risk factors of severe hemorrhage after PCNL requiring angiography and embolization through to September 2019. The necessary data for each eligible study were extracted by 2 independent reviewers. The Newcastle-Ottawa Scale (NOS) was used for assessing the methodological quality of the included studies. Statistical analyses were conducted using Comprehensive Meta-Analysis version 2 to identify whether there was a statistical association between risk factors and severe hemorrhage post-PCNL. RESULTS: The results of this meta-analysis showed that urinary tract infection (UTI) (OR =1.98, 95% CI, 1.21–3.26, P=0.007), diabetes mellitus (OR =4.07, 95% CI, 1.83–9.06, P=0.001), staghorn stone (OR =3.49, 95% CI, 1.25–9.76, P=0.017), and multiple tracts (OR =2.09, 95% CI, 1.33–3.28, P=0.001) were independent risk factors for severe hemorrhage post-PCNL, while hypertension (OR =1.18, 95% CI, 0.58–2.42, P=0.65) showed no significant statistical difference. CONCLUSIONS: Urologists should focus on the above identified risk factors for severe hemorrhage post-PCNL, including UTI, diabetes mellitus, staghorn stone, and multiple tracts. More high-quality studies with larger sample sizes are needed to validate these conclusions.