The Influence of Access on the Efficacy and Complications in PCNL for Renal Calculi

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.

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“…Sharma et al . [ 12 ] concluded a higher rate of blood transfusion in patients where multiple access tracts were used.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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“…Furthermore, the risks increase with factors such as pre-operative urinary infections, prolonged surgery, surgeon expertise, certain patient characteristics (such as diabetes and obesity) (12)(13)(14), prior PCNL procedures, and intraoperative factors including average renal pressure sustained during PCNL, operative time, number of tracts, and degree of blood loss (11,12). A positive renal pelvis urine culture is also considered a significant risk factor for post-PCNL fever (15). The associations between these factors and the risk of post-PCNL UTIs are largely inconsistent across studies (16).…”

Section: Introductionmentioning

confidence: 99%

The Effect of Antibiotic Therapy Before Percutaneous Nephrolithotomy on the Frequency of Postoperative Complications: A Retrospective Cross-Sectional Study

Bonyad,

Falahatkar,

Bamdad Soofi

et al. 2024

Nephro-Urol Mon

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Background: Percutaneous nephrolithotomy (PCNL) is commonly used in the treatment of large renal stones. Postoperative infections are a common consequence of these procedures. Objectives: The purpose of this study is to evaluate the effects of antibiotic therapy before PCNL on the possibility of developing fever and common complications after the procedure. Methods: We carried out a retrospective cross-sectional study involving 708 patients who had undergone PCNL at Razi Hospital in Rasht, covering the period from 2012 to 2022. Patients were allocated into two groups: Group 1 included 454 patients who had received antibiotic therapy, and group 2 included 254 patients who had not received pre-operative antibiotic therapy. Results: In group 1, there were 241 males (53.1%) and 213 females (46.9%), while in group 2, there were 138 males (54.3%) and 116 females (45.7%). In group 1, 82.7% of patients treated with antibiotics had a negative culture. The hospitalization time was 4.00 ± 1.75 days for group 1 and 2.26 ± 1.56 days for group 2. Fever was observed in 39 patients (11.2%) in group 1. Sepsis was seen in only one patient (0.3%) in group 1. There is a significant relationship between total hospitalization time (P = 0.000), hospitalization after the operation (P = 0.000), hypertension (P = 0.009), ischemic heart disease (P = 0.050), history of shock wave lithotripsy (P = 0.003), hydronephrosis (P = 0.000), age (P = 0.004), and hemoglobin levels (P = 0.000) with antibiotic therapy. Conclusions: Surgeon overprescription of antibiotics may lead to resistance, complicating outcomes and extending hospital stays after PCNL. Some complications remain unaffected by antibiotic therapy due to surgical experience.

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“…Furthermore, the risk of post-PCNL infection is increased with positive pre-operative urinary culture, female sex, operative time, use of a nephrostomy tube, diabetes mellitus (DM), body mass index (BMI), pelvicalyceal system dilatation [10,11], prior PCNL procedures, and intraoperative factors including average renal pressure sustained during PCNL, operative time, number of tracts and degree of blood loss [9,10]. Positive renal pelvis urine culture is also considered a signi cant risk factor for post-PCNL fever [12]. The associations between these factors and the post-PCNL risk of UTIs are largely inconsistent across studies [13].…”

Section: Introductionmentioning

confidence: 99%

The effect of antibiotic therapy before percutaneous nephrolithotomy on the frequency of postoperative complications

Falahatkar,

Jafari,

Afzalipoor

et al. 2023

Preprint

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Purpose: Stone disease is affecting 0.13% of the population in the world, and percutaneous nephrolithotomy (PCNL) could be effective and safe to treat complex or large volumes of nephrolithiasis. PCNL may have considerable risks and complications, such as fever. Patients and Methods: We conducted a retrospective clinical study on 708 patients who underwent PCNL in the Razi Hospital. Patients were allocated into two groups; group 1 included 454 patients with at least an antibiotic therapy experience, and group 2 included 254 patients without pre-operative antibiotic therapy. Results: 241(53.1%) males and 213(46.9%) females were in group 1, and 137(53.9%) males and 116(45.7%) females were in group 2. 82.7% of patients treated with antibiotics had a negative culture. The hospitalization time in patients was 4.00± 1.74 days (group 1) and 2.26 ± 1.5 days (group 2). The fever was seen in 39(11.9%) patients (group 1). Sepsis was seen in only one patient in group 1 (0.3%). There is a significant relationship between total hospitalization (P-value=0.000), hospitalization after operation (P-value=0.000), hypertension (p-value =0.009), ischemic heart disease (p-value =0.050), history of shock wave lithotripsy (p-value =0.003), hydronephrosis (p-value =0.000), age (P-value=0.004), and hemoglobin (P-value=0.000) with antibiotic therapy. Conclusion: A few patients who underwent PCNL suffer from fever despite antibiotic therapy. Overall, we found that antibiotic therapy does not play an effective role in reducing post-operative fever.

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The Influence of Access on the Efficacy and Complications in PCNL for Renal Calculi

Cited by 3 publications

References 25 publications

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

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

The Effect of Antibiotic Therapy Before Percutaneous Nephrolithotomy on the Frequency of Postoperative Complications: A Retrospective Cross-Sectional Study

The effect of antibiotic therapy before percutaneous nephrolithotomy on the frequency of postoperative complications

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