Factors predicting postoperative febrile urinary tract infection following percutaneous nephrolithotomy in prepubertal children

Kaygısız, Onur; Satar, Nihat; Güneş, Ali; Doğan, Hasan Serkan; Erözenci, Ahmet; Özden, Ender; Pişkin, Mehmet Mesut; Demirci, Deniz; Toksöz, Serdar; Cicek, Tufan; Gürocak, Serhat; Kılıçarslan, Hakan; Nazlı, Oktay; Kefi, Aykut; İzol, Volkan; Beytur, Ali; Sarıkaya, Şaban; Tekgül, Serdar; Önal, Bülent

doi:10.1016/j.jpurol.2018.04.010

Cited by 17 publications

(14 citation statements)

References 23 publications

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“…23 The pediatric PCNL literature shows that transfusion rates range between 3.8% and 15.3%. [17][18][19]22,[24][25][26] In accordance with the literature, in our series, 12.9% of the patients required blood transfusion. In our series, transfusion rates were higher in the infantile/toddler group, although the difference did not reach statistical significance.…”

Section: Discussionsupporting

confidence: 91%

“…Other series in the literature report postoperative UTI rates differing between 3.5% and 6%, which are similar to our series. 24,25 Kaygısız and colleagues stated young age as a predictive factor for UTI development. 25 On the contrary, in our study, no difference was observed between the infantile/toddler group and the preschool group in terms of UTI rates.…”

Section: Discussionmentioning

confidence: 99%

“…24,25 Kaygısız and colleagues stated young age as a predictive factor for UTI development. 25 On the contrary, in our study, no difference was observed between the infantile/toddler group and the preschool group in terms of UTI rates. One explanation for this difference may be the use of different criteria for the classification of the age groups.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of Percutaneous Nephrolithotomy in Preschool Age Group: A Single-Center Study

Haberal

Doğan

Çıtamak

et al. 2020

Journal of Endourology

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Objective: To determine the factors affecting the outcomes of percutaneous nephrolithotomy (PCNL) in patients in infantile/toddler and preschool age group. Materials and Methods: The data of 186 renal units from 152 patients who underwent PCNL were retrospectively analyzed. Patients under £72 months of age were included in the study. The patients were divided into two groups according to their age: infantile/toddler and preschool group. Demographics and stone features were compared between infantile/toddler and preschool age groups. Effects of different factors on complications and stone-free rates were investigated. Comparisons in the study were done using SPSS 24.0 software for Windows. Results: The mean age of the patients was 40.5-16.5 months, and the female/male ratio was 87/99. The median stone burden was 1.92 cm 2 (0.12-20). Stone-free rates were 75.3% and 84.4% when cases with Clinically Insignificant Residual Fragments were also included. The numbers of patients with Clavien grade 1, grade 2, and grade 3b complications were 7 (3.8%), 39 (21%), and 9 (4.8%), respectively. There was no difference between infantile/toddler and preschool children in terms of stone-free and complication rates (p = 0.082, p = 0.088, respectively). Mini PCNL and tubeless-totally tubeless-urinary diversion techniques were more frequently performed in the infantile/toddler group compared to the preschool group (p = 0.001, p = 0.028, respectively). Presence of staghorn stone was the only significant factor for complications, while the number of stones was significant for stone-free rates for patients £72 months (p = 0.012, p = 0.001, respectively). Stone burden was the only predictive factor for complications in patients aged £36 months, while number of stones was predictive for success in patients aged between 37 and 72 months (p = 0.034, p = 0.006, respectively). Conclusion: PCNL is a feasible and effective method in preschool age group with acceptable complications and high success rates. Presence of staghorn stone is predictive for complications, while number of stones is predictive for success in the preschool age group.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Outcomes of Percutaneous Nephrolithotomy in Preschool Age Group: A Single-Center Study

Haberal

Doğan

Çıtamak

et al. 2020

Journal of Endourology

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“…In this study, antegrade irrigation was performed with gravity instead of positive pressure. Intrarenal pressure is a major factor in postoperative morbidity, including infection [14, 29, 30]. However, our study showed no difference in UTI prevalence between the two groups, which could be because the intrarenal pressure possibly passed from the renal pelvis to an open water channel of the ureteroscope.…”

Section: Discussionmentioning

confidence: 54%

The Role of Antegrade Irrigation via Percutaneous Nephrostomy on Surgical Outcomes in Semirigid Ureteroscopy among Patients with Upper Ureteral Stones

Jung

Byun

Lee

2019

BioMed Research International

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Objective. We aimed to investigate the role of antegrade irrigation via percutaneous nephrostomy on surgical outcomes in retrograde ureteroscopy in patients with upper ureter stones. Materials and Methods. In this retrospective study, we analyzed 134 patients who underwent retrograde semirigid ureteroscopy for upper ureter stones between August 2012 and December 2017. Patients were divided into two groups: retrograde irrigation group (conventional URS) and antegrade irrigation group (using percutaneous nephrostomy). Operation time, postoperative hospital stay, complications, and stone-free rate were measured for each patient after ureteroscopy. Results. The mean age in the retrograde irrigation and antegrade irrigation groups was 53.3 and 60.7 years, respectively (p=0.007). The operation time was 60.8 min vs. 43.0 min (p=0.002), and stone-free rate was 82.0 % vs. 95.5 % (p=0.033). Stone size, laterality, the proportion of male patients, and urinary tract infection prevalence were comparable between the groups. In the subgroup analysis of stone size >10 mm, the antegrade irrigation group had a shorter operation time and a higher stone-free rate. For stone size of 5–10 mm, operation time in the antegrade irrigation group was shorter and the stone-free rate between the two groups was comparable. Conclusion. Antegrade irrigation via percutaneous nephrostomy during ureteroscopy has a higher stone-free rate with a shorter operation time without an increased urinary tract infection risk. Therefore, if percutaneous nephrostomy is necessary before ureteroscopy, antegrade irrigation of external fluid via percutaneous nephrostomy is strongly recommended.

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“…Moreover, we also found that SIRS and sepsis were related to the operation time. This may be due to the long operation time leading to long-term infusion of infectious substances released during the operation 25 . In current study, it may be that the body and the infused liquid have been in heat exchange due to the long operation, so the body temperature is seriously lost.…”

Section: Discussionmentioning

confidence: 99%

Predicting and comparing postoperative infections in different stratification following PCNL based on nomograms

Jiang

Guo

Yang

et al. 2020

Sci Rep

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To discuss the mechanisms of infection complications in different degrees after percutaneous nephrolithotomy (pcnL) through predicting and comparing post-pcnL infections based on nomograms, a retrospective cohort study was conducted among 969 cases who underwent PCNL from Dec 5, 2016 to Dec 25, 2017 in Kunming, Yunnan Province. We examined clinical features, urine routine, blood routine, blood biochemistry, imaging studies and operative information and recorded the examination results before surgery for univariate and multivariate logistic regression. We applied receiver operating characteristic curves, calibration curves, accuracy, specificity, sensitivity, positive predictive value and negative predictive value to evaluate and compare the models. Nomograms were used to visualize the different degrees of postoperative infection complications. The risk scores of the three groups were compared by diabetes mellitus distribution. Our results suggest that the more severe the infection is, the more accurate the model predicts and that the occurrence of severe infection mostly is related to the patients' homeostasis. Hence, we developed an online post-PCNL sepsis dynamic nomogram which can achieve visualization and dynamically predict the incidence of sepsis in postoperative patients. Kidney stones, one of the most common urologic diseases, show an upward trend annually 1 , especially in Southwest China where the incidence rate is higher than those in other parts of the country 2. PCNL is used as the standard method in the treatment of upper urinary tract stone > 2 cm 3 with minimal invasion and a faster and higher stone clearance rate 4. However, complications are reported including fever (21.0-32.1%), blood transfusion (11.2-17.5%), extravasation (7.2%) and septicemia (0.3-4.7%) 5. Infection, as a major complication, is graded into fever, systemic inflammatory response syndrome (SIRS), and sepsis according to the severity. Previous studies have reported the risk factors on the severity of infectious complications, such as gender, nephrostomy 6 , preoperative positive urine culture 7 , stone size 8 , age, diabetes mellitus and complex stones 9. Risk factors of SIRS include PCNL operation history, stone size, degree of hydronephrosis, complex stones, preoperative positive urine culture, perfusion pressure, and neurogenic bladder and the use of antibiotics 10-13. Risk factors of sepsis include stone burden, infectious stone, the number of tracts, preoperative positive urine culture, leukopenia, creatinine and operation time 14-17. Nonetheless, most studies only discussed one or two infection outcomes and did not compare similarities and differences of infection concurrency between different degrees in the same samples. In this study, we established models to predict and to study the infection complications of different degrees after PCNL, and compared the differences between the models to illustrate the different infection mechanisms and the clinical significance. Finally, we developed online application to achieve visu...

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Factors predicting postoperative febrile urinary tract infection following percutaneous nephrolithotomy in prepubertal children

Cited by 17 publications

References 23 publications

Outcomes of Percutaneous Nephrolithotomy in Preschool Age Group: A Single-Center Study

Outcomes of Percutaneous Nephrolithotomy in Preschool Age Group: A Single-Center Study

The Role of Antegrade Irrigation via Percutaneous Nephrostomy on Surgical Outcomes in Semirigid Ureteroscopy among Patients with Upper Ureteral Stones

Predicting and comparing postoperative infections in different stratification following PCNL based on nomograms

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