Introduction. An evaluation and prognosis of complications of different treatment options in patients with staghorn stones are necessary to choose optimal surgical strategy and perioperative prophylaxis on individualized basis. Intra- and postoperative thrombotic and hemorrhagic complications are not still well-studied in modern operative urology.
Aim. To explore the influence of morpho-densitometry changes of blood platelets on perioperative thrombotic and hemorrhagic complications in patients with staghorn nephrolithiasis after percutaneous nephrolithotomy (PCNL).
Materials and methods. Data of 292 patients aged from 20 до 77 (mean 53,4±12,3) yrs after PCNL with staghorn stones were included in the retrospective study. We used a method of quantitative phase imaging of peripheral blood platelets on the domestic microscopic phase interference device MIM-320 (“Amphora”, Moscow, Russia). Particular functional activity of 4 morphologic types of living cells based on a degree of activity was evaluated.
Results and discussion. In patients with staghorn stones, significant morpho-functional changes in the platelets were observed: the average cell diameter exceeded the control values by 1.2 times, the perimeter by 1.4 times, the area by almost 2 times, and the volume by 1.3 times. The state of platelet hemostasis in patients with staghorn stones can be assessed as a state of "stress with elements of decompensation". Intraoperative examination of platelets showed a decrease in cell size (diameter, perimeter, area, and volume) with a slight increase in their phase height, possibly due to cell spherization as a stage of preparation for their activation. These changes persisted on the 3rd and 5th days after surgery.
A positive correlation was found between the size of the stone and platelets type 3 intraoperatively (r=0.590, p<0.05). The duration of the surgery positively correlated with platelets type 4 on the 5th day after surgery (r=0.646, p<0.05), a negative correlation was found with the height (r= -0.767, p<0.05) and platelets type 2 (r= -0.747, p<0.05) on the 5th day. The time of ultrasonic stone fragmentation positively correlated with platelet type 4 intraoperatively (r=0.740, p<0.05), mean diameter (r=0.610, p<0.05), perimeter (r=0.628, p<0.05) and area (r=0.710, p<0.05) of platelets on the 5th day.
Intraoperative bleeding positively correlated with platelet type 2 in patients preoperatively (r=0.7312, p<0.05). A history of type 2 diabetes mellitus (T2DM) positively correlated with the area of platelets intraoperatively (r=0.615, p<0.05), as well as the perimeter (r=0.592, p<0.05), 2nd (r=0.635, p<0.05) and platelet type 3 (r=0.592, p<0.05) on the 3rd day, the area (r=0.615, p<0.05) and volume (r=0.717, p<0.05) of platelets on the 5th day, and the platelets type 2 (r=0.590, p<0.05) on the 5th day. A negative correlation was observed between T2DM and platelet type 1 (r= -0.720, p<0.05) on the 3rd day. Preoperative thrombin time negatively correlated with platelet type 3 before surgery (r= -0.712, p<0.05). Preoperative platelet counts negatively correlated with platelet area on day 5 after procedure and the presence of T2DM.
Conclusion. Morpho-densitometric parameters of peripheral blood platelets objectively reflect the functional adequacy of this component of hemostasis. Platelet anergy, i.e. the absence of platelet response to external intervention (surgery), is evidence of a decompensated state of the platelet component and can serve as a prognostic risk factor for the development of intra- or postoperative bleeding.

Keywords: perioperative hemorrhage, predictors of thrombotic and hemorrhagic complications, minimal invasive surgical treatment, PCNL, staghorn nephrolithiasis