Does a Smaller Tract in Percutaneous Nephrolithotomy Contribute to High Renal Pelvic Pressure and Postoperative Fever?

Zhong, Wen; Zeng, Guohua; Kaijun, Wu; Li, Xun; Chen, Wenzhong; Yang, Houmeng

doi:10.1089/end.2008.0001

Cited by 148 publications

(78 citation statements)

References 16 publications

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“…Specifically, patients who sustained intra pelvic pressures >30 mm Hg for more than 30 s were more likely to develop postoperative fever [20]. Although we did not measure intra pelvic pressures, but we observed that patients with longer operative had significantly higher SIRS rates.…”

Section: Discussionmentioning

confidence: 98%

Systemic Inflammatory Response Syndrome Following Percutaneous Nephrolithotomy: Assessment of Risk Factors and Their Impact on Patient Outcomes

et al. 2016

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Objectives: To identify perioperative risk factors for postoperative systemic inflammatory response syndrome (SIRS) and suggest possible modifications to reduce morbidity. Material and Methods: We prospectively analysed perioperative data such as history of pervious stone surgery, number and configuration of stones, presence of stent or nephrostomy, any previous positive urine culture, intraoperative renal pelvic urine and stone culture, aspiration of turbid urine on initial puncture, number of tracts required and clearance of stones, operative time and intraoperative hypotension and tachycardia of all patients who underwent percutaneous nephrolithotomy over a period of 15 months. Results: A total of 182 patients were included, average stone size was 2.8 cm, 36.2% had staghorn stones and 15.9% had an indwelling stent or nephrostomy. Despite sterile preoperative urine culture, renal pelvic urine culture (RPUC) was positive in 14.8% (27 patients) and stone culture was positive in 21.9% (40 patients). SIRS developed in 17.5% (32 patients) and septic shock in 1.09% (2 patients). On analysis younger age, positive RPUC and stone culture, longer operative time and intraoperative tachycardia correlated significantly with the development of SIRS. Conclusion: Intra-operative cultures are only therapy-guiding cultures during SIRS, as preoperative urine cultures seldom accurately depict bacteriological status of upper tracts and thus should be obtained in all patients.

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Section: Discussionmentioning

confidence: 98%

Systemic Inflammatory Response Syndrome Following Percutaneous Nephrolithotomy: Assessment of Risk Factors and Their Impact on Patient Outcomes

et al. 2016

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“…The establishment of smaller channels greatly reduced the incidence of bleeding complications, allowing breakthrough advances in clinical applications [19]. Although Zhong et al [20] proved that mean intrapelvic pressure of the minimum tract (14 F) in multiple-tract PCNL was still lower than the backflow (30 mm Hg), we still believe that a smaller working channel is less efficient and takes more time. It can also restrict irrigation outflow, causing the absorption of microorganisms and endotoxins from the fragmented calculi.…”

Section: Discussionmentioning

confidence: 99%

Single-Stage Multiple-Tract Percutaneous Nephrolithotomy in the Treatment of Staghorn Stones under Total Ultrasonography Guidance

Fei

Song

et al. 2014

Urol Int

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Objective: To evaluate the safety and efficacy of single-stage multiple-tract percutaneous nephrolithotomy (PCNL) in the treatment of staghorn stones solely guided by ultrasonography (US). Patients and Methods: From May 2007 to July 2012, 55 single-stage multiple-tract PCNL procedures were performed (53 patients, of whom 2 had bilateral stones). Caliceal puncture and dilatation were performed under US guidance in all cases. The procedure was evaluated for access success, length of postoperative hospital stay, complications (modified Clavien system), and stone clearance. Results: The mean (±SD) operating time was 84.87 ± 24.9 min, with a mean (±SD) postoperative hospital stay of 5.2 ± 1.31 days. The patients experienced a mean (±SD) decrease in hemoglobin level of 8.23 ± 2.39 g/l and the stone-free rate after single-stage surgery was 78.18%. Extracorporeal shock wave lithotripsy was indicated in 2 cases as an auxiliary treatment. There were 10 grade 1 (62.5%) and 6 grade 2 (37.5%) complications; however, there were no complications above grade 3. Conclusion: Total US-guided single-stage multiple-tract PCNL for treating staghorn calculi in selected cases is safe, feasible, and may be performed with an acceptable morbidity and with the advantage of preventing radiation hazards and damage to adjacent organs.

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“…3 In 1998, we consolidated the procedure into a single stage and have since used this technique for all stones. [4][5][6][7] Large and complex stones constitute advanced calculus disease. The management strategy depends on the stone burden and their locations in the collecting system.…”

Section: Introductionmentioning

confidence: 99%

Minimally Invasive Percutaneous Nephrolithotomy for Simple and Complex Renal Caliceal Stones: A Comparative Analysis of More Than 10,000 Cases

Zeng

Zhao

Wan

et al. 2013

Journal of Endourology

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AbstractsPurpose: To determine whether minimally invasive PCNL (MPCNL) is as safe and effective in the management of complex renal caliceal stones as it is for simple renal stones. Patients and Methods: We retrospectively reviewed 5761(41.2%) simple caliceal stones (isolated renal pelvis including isolated calix) and 8223 (58.8%) complex caliceal stones (renal pelvis accompanying two calices at least) that were managed by MPCNL between 1992 nd 2011. The safety, efficacy, and outcome were compared and analyzed. Results: Stone burden was larger in complex caliceal stones (1763.0 vs 1018.6 mm 2 , P < 0.05). Patients with simple stones had significantly shorter operative time, less frequency of multiple percutaneous accesses, and less hemoglobin drop. They also had a higher initial stone-free rate (SFR) (77.6% vs 66.4%) after a single session of MPCNL (P < 0.05). The differences diminished in the final SFR (86.7% vs 86.1%) after relook and/or auxiliary procedures (P > 0.05). The complication rate (17.9% vs 19.0%) and blood transfusion rate (grade II) (2.2% vs 3.2%) were similar in both groups (P > 0.05). Both groups had a low rate of high Clavien grade complications. Renal vascular embolizations (grade III), however, were significantly higher in patients with complex caliceal stones (P < 0.05). Conclusions: MPCNL is a safe and effective treatment option for patients with complex caliceal stones except there is a slightly higher frequency rate of embolization. There was a higher initial SFR in simple stones, but this difference diminished with secondary procedures.

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Does a Smaller Tract in Percutaneous Nephrolithotomy Contribute to High Renal Pelvic Pressure and Postoperative Fever?

Cited by 148 publications

References 16 publications

Systemic Inflammatory Response Syndrome Following Percutaneous Nephrolithotomy: Assessment of Risk Factors and Their Impact on Patient Outcomes

Systemic Inflammatory Response Syndrome Following Percutaneous Nephrolithotomy: Assessment of Risk Factors and Their Impact on Patient Outcomes

Single-Stage Multiple-Tract Percutaneous Nephrolithotomy in the Treatment of Staghorn Stones under Total Ultrasonography Guidance

Minimally Invasive Percutaneous Nephrolithotomy for Simple and Complex Renal Caliceal Stones: A Comparative Analysis of More Than 10,000 Cases

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