Severe Sepsis following Percutaneous or Endoscopic Procedures for Urinary Tract Stones

O’Keeffe, Nicholas; Mortimer, A.J.; Sambrook, P.; Rao, P. N.

doi:10.1111/j.1464-410x.1993.tb00717.x

Cited by 109 publications

(53 citation statements)

References 16 publications

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“…This holds true for PCNL also. Post PCNL SIRS is commonly reported in about 20-30% of patients and has the potential to progress to severe sepsis (0-3%), which has mortality rates of 50-60% [2,3,6,7]. Thus, minimising infection-related complications is priority to maintain low morbidity rates.…”

Section: Discussionmentioning

confidence: 99%

“…Incidence of sepsis is 40-50% if RPUC or stone culture is positive as compared to 25% if previous urine culture was positive and only 14 and 9% if RPUC and stone culture are sterile respectively. However, those who developed SIRS, around half of them had sterile renal pelvic urine and stone culture underscoring the role of endotoxins from dead bacteria in inciting SIRS and sepsis [6,17,18]. …”

Section: Discussionmentioning

confidence: 99%

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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: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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“…Endoscopic treatment of the urinary tract in the presence of stones can induce bacteremia, endotoxemia, and septic shock [4,6,[10][11][12][13] . Urosepsis following PCNL can be explained by stone-colonizing bacteria and bacterial endotoxins in combination with the positive pressure of irrigation.…”

Section: Discussionmentioning

confidence: 99%

Role of Preoperative and Intraoperative Factors in Mediating Infection Complication following Percutaneous Nephrolithotomy

Lojanapiwat

Kitirattrakarn

2011

Urol Int

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Objective: To identify the pre- and intraoperative factors that affect the development of postoperative systemic inflammatory response syndrome (SIRS) following percutaneous nephrolithotomy (PCNL). Patients and Methods: A total of 200 patients were treated with PCNL, 56 of which developed postoperative SIRS (group I) and 144 did not (group II). For these 2 groups, the patient factor, operative factor, preoperative urine culture, pelvic urine culture, and stone culture were compared. Results: Average age, stone size, operative time, success rate, and number of tubeless PCNL were not significantly different between the 2 groups. However, preoperative urine culture, pelvic urine culture, and stone culture, respectively, were positive in 66.1, 46.4 and 48.2% of the patients in group I, but only 10.4, 3.5 and 3.5% for the corresponding specimens in group II. In addition, 5 patients in group I developed clinical septic shock, 4 of which were positive for all cultures and 1 positive only for stone culture. Conclusion: Infection following PCNL is common, but only a few cases progress to septic shock. Positive preoperative urine, intraoperative pelvic urine and stone cultures are important factors indicating the development of postoperative SIRS. Intraoperative cultures are important for decision-making about the treatment of postoperative infection complications.

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“…12 Incidence of sepsis associated with obstructed uropathy and urinary stones treated surgically has also been reported in 1.28% of cases. 13 Rao et al found an incidence of septic shock after endoscopic manipulation for urinary stone in about 1% of treated patients. Sepsis is not so prevalent in cases of UTI secondary to calculus.…”

Section: Discussionmentioning

confidence: 99%

Study of prognostic factors affecting outcome of urosepsis in a tertiary care hospital in Mumbai

2016

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Severe Sepsis following Percutaneous or Endoscopic Procedures for Urinary Tract Stones

Cited by 109 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

Role of Preoperative and Intraoperative Factors in Mediating Infection Complication following Percutaneous Nephrolithotomy

Study of prognostic factors affecting outcome of urosepsis in a tertiary care hospital in Mumbai

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