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

Abstract

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.

Effect of Obesity on Outcomes of Percutaneous Nephrolithotomy in Renal Stone Management: A Systematic Review and Meta-Analysis

“…However, the application of ESWL in obese patients is limited because of the skin-tokidney distance and the burden of the existence of large stones; similarly, the application of RIRS in obese patients with stones >2 cm is limited [7] . PCNL is the gold standard first-line treatment in the management of renal stones larger than 2 cm [19] . Obesity is generally speculated to increase the morbidity of surgery, primarily because of wound, pulmonary, and cardiac complications [20] .…”

Risk Factors for Urosepsis after Minimally Invasive Percutaneous Nephrolithotomy in Patients with Preoperative Urinary Tract Infection

“…It has been found that urosepsis after MPCNL might lead to high mortality especially among patients with complex stones [15]. It is of great importance for clinicians to detect postoperative systemic inflammatory response syndrome (SIRS) and prevent SIRS from progressing to urosepsis [16]. Previous studies have found a significant association between preoperative UTI and urosepsis after endoscopic surgeries for upper urinary tract stones [17,18].…”

Establishment of a Predictive Model for Factors Related to Systemic Inflammatory Response Syndrome (SIRS) after Percutaneous Nephrolithotomy (PCNL)

“…A cross-sectional survey of the prevalence of urinary calculi in China showed that the prevalence rate was 6.50% (1). Percutaneous nephrolithotomy (PCNL) has been widely used for the treatment of renal stones (2), and it has also become the standard of care for large (>2 cm) renal stones (3). PCNL has become one of the main methods used to treat renal and upper ureteral calculi in recent years.…”