Evaluating the efficacy of bimanual compression of abdomen-flank to control postoperative bleeding after percutaneous nephrolithotomy: A randomized clinical trial

Purpose: To investigate the influence of bimanual compression of abdomen-flank to control bleeding after completion of percutaneous nephrolithotomy (PCNL) including tubeless PCNL. Materials and methods: This study is a parallel-group randomized clinical trial with 1:1:1 randomization. Ninety patients who were candidates for PCNL during July to October 2019 were enrolled. After completion of PCNL operation, patients were randomized into three groups to receive bimanual abdomen-flank compression for 0, 3, and 7 min by the operating surgeon with the opening of sealed envelopes (groups 0, 3, and 7 min afterwards). Preoperative, 24, and 48 h postoperative hemoglobin (Hb) and electrolytes were collected. The primary endpoint of interest was the comparison of 48-h blood loss across study groups. Secondary endpoints included the percent drop in 24- and 48-h Hb, transfusion rates, and operation complications. This trial is registered at with the following number: IRCT20190618043925N1 on 18 July 2019. Results: There was no statistically significant difference in study groups regarding stone mass, stone location, access location, and patients' age (all p > 0.05). The medians (IQR) of 48-h blood loss were 490 mL (105-916), 338 mL (160-933), and 413 mL (71-650) in groups of 0, 3, and 7 min. The percent drop in 24-h postoperative Hb relative to preoperative Hb were 11.5 +/- 8.6% versus 9.2 +/- 7.3% versus 9.3 +/- 6.8% (p = 0.44) and relative values for the percent drop in 48-h Hb relative to preoperative Hb were 8.6 +/- 8.7% versus 9.5 +/- 9.9% versus 7.2 +/- 9.6% (p = 0.63) in groups of 0, 3, and 7 min respectively. Transfusion was needed in four patients in group 0 min, five patients in group 3 min, and three patients in group 7 min. Conclusions: The results of this study reveal that postoperative bimanual compression of abdomen-flank has no statistically significant influence on the control of bleeding after PCNL operations.