Effect of tranexamic acid irrigation on perioperative blood loss during mini-percutaneous nephrolithotomy: A pilot double-blind randomised controlled trial

Objective: To evaluate the efficacy and safety of adding 0.1% tranexamic acid (TXA) to irrigation fluid in reducing perioperative blood loss during mini-percutaneous nephrolithotomy (mini-PCNL). Patients and Methods: In this prospective, randomised study, 40 patients undergoing mini-PCNL were allocated to receive irrigation fluid containing either 0.1% TXA (n = 20) or distilled water (placebo; n = 20). The outcomes assessed included changes in haemoglobin, estimated blood loss, operative duration, irrigation volume, length of hospital stay, transfusion requirements, stone clearance and TXA-related adverse events. Results: Baseline characteristics were comparable between the two groups. The TXA group had significantly less haemoglobin decline (0.5 g/dl vs. 1.5 g/dl) and lower estimated blood loss (91.7 ml vs. 169.0 ml) compared with the placebo group (both p < 0.05). Operative time and hospital stay were also shorter in the TXA group (p < 0.05). Transfusion rate and irrigation volume were lower in the TXA group, while stone clearance rates were comparable between the groups (90% vs. 85%; p = 0.633). No TXA-related adverse events were observed. Conclusion: The addition of 0.1% TXA to irrigation fluid during mini-PCNL significantly reduces perioperative blood loss and appears to be safe in this pilot cohort, without increasing complications observed in the study.