Clinical analysis of ultrasound-guided "tract without bleeding vessel requiring embolization (TBVE)" in reducing bleeding during percutaneous nephrolithotomy.

Objective: To compare the efficacy of ultrasound-guided tract without bleeding vessel requiring embolization (TBVE) versus conventional minimally invasive access in mini-percutaneous nephrolithotomy (Mini-PCNL) for reducing postoperative bleeding.

Methods: This retrospective study analyzed 188 patients who underwent Mini-PCNL by a single surgeon between June 2021 and July 2023. Patients scheduled for mini-PCNL were assigned to two groups based on access technique. The first group had no TBVE (Standard mini-PCNL, n = 95) and the second group had TBVE (TBVE-assisted Standard mini-PCNL, n = 93). Baseline characteristics-including gender, age, body mass index (BMI), stone location, stone size, and preoperative hemoglobin levels-were balanced (P > 0.05). Perioperative outcomes were compared using t-tests and χ² tests.

Results: The TBVE-assisted mini-PCNL showed superior hemorrhage control, with significantly higher postoperative hemoglobin levels (111.32 ± 24.36 g/L vs. 120.13 ± 15.27 g/L, P < 0.05), smaller 24-hour hemoglobin declines (16.23 ± 15.27 g/L vs. 8.30 ± 7.21 g/L, P < 0.05), and fewer embolization-requiring events (6 vs. 1 case; P < 0.05). Operative time was comparable between groups (Mini-PCNL: 65.42 ± 34.97 min vs. TBVE: 67.73 ± 32.02 min, P > 0.05).

Conclusion: TBVE significantly reduces the risk of bleeding in Mini-PCNL compared to conventional access, as evidenced by reduced hemoglobin loss and fewer embolization requirements, without significantly prolonging operative time. This technique enhances procedural safety in the management of complex renal calculi.