Predictors of Blood Transfusion Following Percutaneous Nephrolithotomy: A Systematic Review and Meta-analysis

Aldwin Arifin (Departemen Urologi, Fakultas Kedokteran, RSUPN Dr. Cipto Mangunkusumo, Universitas Indonesia, Jakarta, Indonesia)
Nur Rasyid (Departemen Urologi, Fakultas Kedokteran, RSUPN Dr. Cipto Mangunkusumo, Universitas Indonesia, Jakarta, Indonesia)
Ponco Birowo (Departemen Urologi, Fakultas Kedokteran, RSUPN Dr. Cipto Mangunkusumo, Universitas Indonesia, Jakarta, Indonesia)
Widi Atmoko (Departemen Urologi, Fakultas Kedokteran, RSUPN Dr. Cipto Mangunkusumo, Universitas Indonesia, Jakarta, Indonesia)

Media of Health Research
Vol. 4 No. 3 (2026): Media of Health Research, August 2026

Percutaneous nephrolithotomy (PCNL) is the standard treatment for large renal calculi, yet clinically significant hemorrhage necessitating transfusion remains a critical perioperative challenge. This PRISMA-guided systematic review and meta-analysis aimed to consolidate the evidence on predictors of blood transfusion or severe bleeding after PCNL. Pooled analyses identified diabetes mellitus, hypertension, urinary tract infection, renal anomalies, multiple or staghorn stones, solitary kidney phenotype, multiple access tracts, larger stone size, and longer operative time as significant risk factors. Notably, hydronephrosis demonstrated an inverse association. In conclusion, post-PCNL bleeding requiring transfusion is best conceptualized as a three-domain risk paradigm: patient susceptibility, stone complexity, and procedural intensity.