Predictive factors for fever and sepsis following percutaneous nephrolithotomy: A review of 580 patients

Abstract

Aims:There has been much speculation and discussion about the infective complications of percutaneous nephrolithotomy (PCNL). While fever is common after PCNL, the incidence of it progressing to urosepsis is fortunately less. Which patient undergoing PCNL is at risk of developing urosepsis and in whom aggressive treatment of fever postoperatively may prevent the progression to severe sepsis becomes a very important question. This study aims to answer these vital questions.Settings and Design:This is a single institutional, retrospective study over a period of 3 years.Materials and Methods:Retrospective analysis of medical records of the patients undergoing PCNL from August 2012 to July 2015 was done. A total of 580 patients were included in the study, and the study variables recorded were analyzed statistically.Statistical Analysis Used:Statistical analysis was performed by Chi-square test.Results:Three factors significantly correlated with postoperative severe sepsis, namely, stone size >25 mm, prolonged operative time >120 min, and significant bleeding requiring transfusion. Factors associated with fever after PCNL which did not progress to sepsis were the presence of staghorn calculi and multiple access tracts in addition to the factors listed above for sepsis.Conclusions:Fever after PCNL is not uncommon but it has a low incidence of progressing to life-threatening severe sepsis and multiorgan dysfunction syndrome. Special precautions and monitoring should be taken in patients with bigger stone (>25 mm) and patients with severe intraoperative hemorrhage requiring blood transfusion. It is better to stage the procedure rather than prolong the operative time (120 min). Identifying these factors and minimizing them may decrease the incidence of this life-threatening complication.

Retrograde intrarenal surgery vs miniaturized percutaneous nephrolithotomy to treat lower pole renal stones 1.5-2.5 cm in diameter

“…PCNL has the advantage of a high stone-clearance rate[13]. Despite advances in technology, PCNL was an invasive surgery with the potential to cause many serious complications[14]. Although doctors have compared either PCNL or RIRS to shock wave lithotripsy to determine which is more suitable for patients with a diameter less than 2 cm, there are still relatively few studies comparing the results of mini-PCNL and RIRS in the treatment of LP renal stones[9].…”

Factors associated with urosepsis following percutaneous nephrolithotomy

“…Urosepsis occurred in only 1% of cases but mortality in these cases was high at 66-80% 1 . Rashid concluded that risk factors for sepsis after PCNL were number of stones, operative time, intraoperative bleeding and presence of residual stones 2 ; these findings differed from those reported by Basal et al who found that stone size more than 2.5 cm and intraoperative hemorrhage requiring transfusion were the risk factors 3 .…”

Early Changes and Predictive Value of Serum Histone H3 Concentration in Urosepsis: A Prospective Observational Study

“…Seeking biomarkers that can be used to predict the occurrence of urosepsis may contribute to the early diagnosis of urosepsis and improve the prognosis of septic patients. Based on previous studies, we supposed that serum histone H3 is the biomarker Since the revision of the international consensus of Sepsis-3, the diagnosis rate of sepsis has greatly improved, revealing sepsis to be among the most serious complications in patients after PCNL, with an incidence ranging from 3.5 to 35.05% [20][21][22][23][24]. The release of kidney stone-colonizing bacteria and other bacterial endotoxins during surgery into the circulation system coupled with elevated renal pelvis pressure is believed to be the main cause of postoperative infection and urosepsis [25,26].…”