Endourology & laparoscopy

Abstract

after initial percutaneous access. The authors attribute their low infectious complication rate to pre-operative treatment of positive urine cultures, percutaneous access and collecting system drainage the day prior to PCNL and aggressive culture-specific intravenous antibiotics after drainage. However, despite their high stone free rate, recurrent stones occurred in 46% of patients within 36 months.This study highlights the potential complications of treating stones in this patient population as well as the high rate of recurrence despite a stone free state. However, it is encouraging that with careful pre-and intraoperative measures, complication rates can be minimized. While the practice of routinely obtaining percutaneous access a day or more prior to the procedure has never been shown in controlled trials to reduce infectious complications, and I personally have not adopted this practice, it does allow renal pelvic urine to be assessed prior to initiating lengthy manipulation of the urinary tract. In addition, although the authors advocate oral antibiotics for 2 days prior to admission, I favor a more prolonged course of 1-2 weeks of culture specific antibiotics to assure at least superficial sterilization of the urinary tract.