To investigate the risk factors affecting bleeding during and after percutaneous nephrolithotomy (PCNL) under solo ultrasound-guided access with axis positioning of two steps punctures.

The clinical data of 1 555 procedures to cure calculus of upper urinary tract in Renmin Hospital of Wuhan University during June 2013 to June 2016 were retrospectively reviewed. The following factors were analyzed, including age, sex, BMI, stone type, diabetes status, hypertension status, stone size, the degree of hydronephrosis, the structure of the collecting system, and the operative factors including size of passage, number of passage, the devices for disintegrating stones. The univariate analysis and Logistic analysis were used to explore possible factors which may cause bleeding during and after PCNL.

All the 1555 procedures were successfully completed by the same surgeon. A total of 56 patients received blood transfusion and the rate of the blood transfusion was 3.6%. Furthermore, 11 patients among those received selective arterial embolisation. According to univariate and logistic analysis, the factors including stone type (P<0.001, OR=-1.963), stone size (P=0.009, OR=1.687), number of passage (P<0.001, OR=2.121), the structure of the collecting system (P<0.001, OR=2.128), diabetes status(P<0.001, OR=1.593) were the main factors affecting blood loss.

PCNL under solo ultrasound-guided access with axis positioning of two steps puncturs is safe and effective. The factors including huge stone especially for staghorn stones, diabetes mellitus, multiple passages and unusual structure of the collecting system were closely related with the bleeding during and after PCNL.