Risk factors for postoperative infectious complications following percutaneous nephrolithotomy: a prospective clinical study

Abstract

The aim of the study was to assess the preoperative and intraoperative potential risk factors for infectious complications after percutaneous nephrolithotomy (PCNL). A total of 303 patients who underwent PCNL for renal stones were included in the recent study. A detailed history including past renal surgery, nephrostomy insertion and recurrent urinary infection were obtained from all patients. Preoperative urine culture, renal pelvic urine culture and stone culture were obtained from all patients. The intraoperative data were prospectively noted. All patients were followed up postoperatively for signs of systemic inflammatory response syndrome (SIRS) and sepsis. In 83 (27.4%) of the patients, SIRS was observed and of these patients 23 (7.6%) were diagnosed as sepsis. Escherichia coli was the most common organism detected in cultures, followed by Pseudomonas aeruginosa, Enterococcus and Klebsiella spp. in all patients. By multivariate logistic regression analysis, presence of infection stone, stone burden and recurrent urinary tract infection were associated with both SIRS and sepsis development. Presence of infection stone, stone burden ≥800 mm(2) and recurrent urinary tract infection can be identified as independent predictors for the development of SIRS and sepsis.

Development and Internal Validation of a Classification System for Predicting Success Rates After Endoscopic Combined Intrarenal Surgery in the Modified Valdivia Position for Large Renal Stones

“…Several recent studies of PCNL that have been undertaken worldwide have reported major complication rates as follows: systemic inflammatory response syndrome in 27.4%, sepsis in 7.6%, severe bleeding in 7.8%, blood transfusions in 5.7%, renal pelvis perforations in 3.4%, severe hemorrhages requiring hemostasis procedures in 2.3%, and hydrothorax in 1.8% of cases, respectively. [26][27][28] Complications were observed at rather lower rates in our study compared with these reports, which may be associated with the safety of the ECIRS procedure itself when it is undertaken in the modified Valdivia position. Another reason underlying the lower complication rates in the present study relates to the operation plans often changing from single sessions to staged ECIRS in complicated situations, including those in which the field of view could not be secured as a consequence of severe bleeding.…”

Risk Factors for Postoperative Complications of Percutaneous Nephrolithotomy at a Tertiary Referral Center

“…2,6,9,15 Several publications have also attempted to evaluate prognostic factors for complications after percutaneous nephrolithotomy. 3,4,6,7,15,16,18,19,24 A failure to use a standardized reporting classification system has made interpretation and comparison of results difficult. To address this issue the M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT modified Clavien scoring system has been assessed and is now recommended for use when reporting endourological surgery outcomes.…”

“…1 Various publications have assessed several clinical, radiological and perioperative variables for their potential influence on postoperative complications. [2][3][4][5][6] Unfortunately, only a few published reports used a specific complication score for urological surgery. 7,8,9 Moreover, until recently, there was a lack of standardization of PCNL reported outcomes.…”

Bacteriological evaluation of the non-struvite nephrolithiasis and its association with urinary tract infections

“…However, we consider that the microbiological investigation of the calculi may be an important investigation, as the bacteria that colonize the calculi can induce bacteriuria/UTI, or even inflammatory response syndrome and sepsis when certain conditions are met (15). The presence of this association, left without an adequate treatment (such as the calculi-free status and proper antibiotherapy) can lead patients to develop recurrence of urolithiasis or even struvite urolithiasis, with wellknown consequences for the urinary system and for the entire human body.…”