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Hasan AM, Riyad AM, Ahmed MA. Predictors of acute kidney injury after percutaneous nephrolithotomy in adult patients: prospective observational study. Int Urol Nephrol 2024; 56:1843-1850. [PMID: 38289546 PMCID: PMC11090918 DOI: 10.1007/s11255-024-03960-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/07/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To assess the frequency and the predictive factors of Acute Kidney injury (AKI) in patients undergoing percutaneous nephrolithotomy (PNL). METHODS A prospective observational work. Demographic, preoperative laboratory data, stone characteristics, and intraoperative and postoperative data were gathered. Perioperative AKI had been defined as an elevation in serum creatinine by ≥ 0.3 mg/dl within 48 h, or ≥ 1.5 times baseline, or urine volume less than 0.5 ml/ kg/hour for 6 hours. A multivariate logistic regression analysis was performed to determine the predictive factors of AKI. ROC curves were utilized to determine the cutoff values of the risk variables. P-values were deemed statistically significant when they were less than 0.05. RESULTS A total of 418 participants had been involved. The frequency of AKI was 13.9, and 17.2% of patients with AKI developed CKD. The risk factors were age > 46.5 years, smoking, BMI > 28.5 kg/m2, hypertension, diabetes, utilization of angiotensin-converting enzyme inhibitors (ACEI), haemoglobin < 10.8 gm/dl, baseline creatinine > 1.41 mg/dl, eGFR < 65.2 ml/min./1.73 m2, serum uric acid > 5.2 mg/dl, stone volume > 1748 mm3, large tract size, long operative time, and intra-operative bleeding. Patients with AKI had a notably extended duration of hospitalization (3.2 days ± 0.45 vs 2.1 ± 0.42, p < 0.001). CONCLUSIONS Perioperative AKI occurred in 13.9% of individuals undergoing PNL. Identification and optimization of the risk factors and meticulous technique during PNL procedures should be attempted to decrease the risk of AKI.
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Affiliation(s)
- Ahmed Mahmoud Hasan
- Urology Department, Faculty of Medicine, South Valley University, Qena, Egypt.
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Falahatkar R, Falahatkar S, Khajavi Gaskarei MA, Afzalipoor M, Mojtahedi A, Aligolighasemabadi N, Deilami A, Mirzaei Dahka S, Keivanlou MH, Jafari A. The global, prevalence, and risk factors of postoperative fever after percutaneous nephrolithotomy: A systematic review and meta-analysis. Asian J Urol 2024; 11:253-260. [PMID: 38680584 PMCID: PMC11053330 DOI: 10.1016/j.ajur.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/26/2022] [Indexed: 05/01/2024] Open
Abstract
Objective This study aimed to explore the global, prevalence, and risk factors of fever after percutaneous nephrolithotomy (PCNL) by conducting a systematic review and meta-analysis. Methods The high-sensitivity searching was conducted without time limitation until December 30, 2020 in Web of Sciences, Scopus, and PubMed based on inclusion and exclusion criteria. Results The prevalence rates of fever and sepsis among patient undergoing PCNL were estimated 9.5% (95% confidence interval [CI]: 9.3%-9.7%), and 4.5% (95% CI: 4.2%-4.8%), respectively. Nephrostomy tube was used in 9.96% (95% CI: 9.94%-9.97%) of patients. The mean preoperative white blood cells of patients were 6.401×109/L; 18.3% and 4.55% of patients were considered as the positive urinary culture and pyuria, respectively. About 20.4% of patients suffered from residual stones. The odds ratios (ORs) of fever in patients who suffering from diabetes mellitus, hydronephrosis, staghorn stones, and blood transfusion were 4.62 (95% CI: 2.95-7.26), 1.04 (95% CI: 0.81-1.34), 2.57 (95% CI: 0.93-7.11), and 2.65 (95% CI: 1.62-4.35), respectively. Patients who underwent PCNL in prone position were more likely to develop fever (OR: 1.23; 95% CI: 0.75-2.00) than patients in supine position. Conclusion The current study showed that patients who suffer from diabetes mellitus, hydronephrosis, staghorn stones, nephrostomy tube or double-J stent, blood transfusion, and also patients who underwent PCNL in prone position surgery are more likely to develop a postoperative fever after PCNL.
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Affiliation(s)
- Reza Falahatkar
- Urology Research Center, Guilan University of Medical Sciences, Guilan, Rasht, Iran
| | - Siavash Falahatkar
- Urology Research Center, Guilan University of Medical Sciences, Guilan, Rasht, Iran
| | | | | | - Ali Mojtahedi
- Microbiology Department, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Neda Aligolighasemabadi
- Department of Internal Medicine, School of Medicine, Guilan University of Medical Siences, Rasht, Iran
| | - Ahmad Deilami
- Urology Research Center, Guilan University of Medical Sciences, Guilan, Rasht, Iran
| | - Samaneh Mirzaei Dahka
- School of Nursing and Midwifery, Guilan University of Medical Sciences, Guilan, Rasht, Iran
| | | | - Alireza Jafari
- Urology Research Center, Guilan University of Medical Sciences, Guilan, Rasht, Iran
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Griffiths L, Aro T, Samson P, Derisavifard S, Gaines J, Alaiev D, Mullen G, Rai A, Williams T, Patel V, Guanay G, Leavitt D, Hartman C, Smith A, Hoenig D, Okeke Z. Prospective Randomized Trial of Antibiotic Prophylaxis Duration for Percutaneous Nephrolithotomy in Low-Risk Patients. J Endourol 2023; 37:1075-1080. [PMID: 37578113 DOI: 10.1089/end.2022.0678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
Introduction and Objective: Postoperative infection and sepsis account for the most common complications following percutaneous nephrolithotomy (PCNL), as high as 14% in low-risk patients. Although the American Urological Association (AUA) recommends perioperative antibiotics for 24 hours or less for PCNL, practice patterns vary regarding duration of antibiotic therapy. We aimed to compare the efficacy of 24-hour antibiotic coverage vs short-course protocol of antibiotic prophylaxis for PCNL. Materials and Methods: Low-risk patients with a sterile preoperative urine culture undergoing PCNL were prospectively randomized to antibiotics for up to 24 hours after procedure (24Hr) or continued until external urinary catheters were removed (CR) study groups. Patients were given a first generation cephalosporin, or ciprofloxacin in patients with penicillin allergy. Exclusion criteria included age <18 years, receiving antibiotics immediately before the procedure, history of urosepsis, presence of indwelling catheter >1 week, multistage procedure, immunosuppression, pregnancy, multiple antibiotic allergies, and patients who are breastfeeding. Results: Ninety-eight patients were randomized to either 24Hr (n = 49) or CR (n = 49). Mean duration of antibiotic administration was 20.6 and 34.0 hours in the 24Hr and CR groups (p = 0.04), respectively. Age, comorbidities, stone size, operative time, number of punctures, dilations, and proportion of "tubeless" procedures were similar between groups. There were no differences in febrile episodes, rates of systemic inflammatory response syndrome, bacteremia, or culture-proven postoperative urinary tract infection between the 24Hr and CR groups. Overall complication rates were similar between groups. In a subgroup analysis which excluded "tubeless" patients (24 and 29 patients in 24Hr and CR groups, respectively), no differences were seen in postoperative outcomes. Conclusions: In a randomized, prospective study, we found that a 24-hour protocol for antibiotic prophylaxis is not associated with increased risk of infection-related events compared to giving antibiotics until external catheters are removed in patients with low infectious risk undergoing PCNL. Clinicaltrials.gov: NCT02579161.
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Affiliation(s)
- Luke Griffiths
- Smith Institute for Urology, Northwell Health, New Hyde Park, New York, USA
| | - Tareq Aro
- Smith Institute for Urology, Northwell Health, New Hyde Park, New York, USA
| | - Patrick Samson
- Smith Institute for Urology, Northwell Health, New Hyde Park, New York, USA
- Department of Urology, Weill Cornell Medicine, New York, New York, USA
| | - Samir Derisavifard
- Smith Institute for Urology, Northwell Health, New Hyde Park, New York, USA
| | - Jacob Gaines
- Smith Institute for Urology, Northwell Health, New Hyde Park, New York, USA
| | - Daniel Alaiev
- Smith Institute for Urology, Northwell Health, New Hyde Park, New York, USA
| | - Gregory Mullen
- Smith Institute for Urology, Northwell Health, New Hyde Park, New York, USA
| | - Arun Rai
- Smith Institute for Urology, Northwell Health, New Hyde Park, New York, USA
| | - Thomas Williams
- Smith Institute for Urology, Northwell Health, New Hyde Park, New York, USA
| | - Vinay Patel
- Smith Institute for Urology, Northwell Health, New Hyde Park, New York, USA
| | - Geoffrey Guanay
- Smith Institute for Urology, Northwell Health, New Hyde Park, New York, USA
| | - David Leavitt
- Smith Institute for Urology, Northwell Health, New Hyde Park, New York, USA
| | | | - Arthur Smith
- Smith Institute for Urology, Northwell Health, New Hyde Park, New York, USA
| | - David Hoenig
- Smith Institute for Urology, Northwell Health, New Hyde Park, New York, USA
| | - Zeph Okeke
- Smith Institute for Urology, Northwell Health, New Hyde Park, New York, USA
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Mekayten M, Heifetz EM, Sompolinsky Y, Lorber A, Duvdevani M, Strahilevitz J. Timing of midstream urine culture before endourological procedure-can we do better?-A comparative study. Urolithiasis 2023; 51:110. [PMID: 37634153 DOI: 10.1007/s00240-023-01483-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023]
Abstract
Endourological procedures are the mainstay of treatment for stone disease in the upper urinary system. Infection is a common complication, and urine cultures (UC) are often obtained preoperatively. In this study, we sought to investigate the role of positive UC in the 90 days prior to surgery (90PreOp) in predicting postoperative infectious complications in comparison to a single positive preoperative UC (PreOP). We compared the correlation between positive PreOp UCs and positive 90PreOp UCs with postoperative urosepsis, and a positive UC obtain proximal to obstruction (Prox UC) during percutaneous nephrolithotomy, ureteroscopy and a placement of nephrostomy tube or ureteral stent. Data from 140 consecutive patients were collected. PreOp UCs were positive in 15 (11%) of patients versus 31 of 140 (22%) positive 90PreOp UCs. All six sepsis events had a positive 90PreOp UC, and five had a positive PreOp UC. Fourteen (93.3%) out of 15 positive Prox UC had a positive 90PreOp UC, whereas only 7 (38.9%) had a positive 90PreOp UC. Positive 90PreOp UC outperformed PreOp UC in predicting positive Prox UC, OR = 12.8 (95% CI 3.70-44.30, p < 0.001), versus OR of 88.9 (95% CI 11.0-720.7, p < 0.001); sensitivity 93%(95% CI 68-100%) versus 47%(95% CI 21-73%); as well as area under the ROC curve(AUC), 0.90 (CI 0.80-0.95) for 90PreOp versus 0.70 (CI 0.56-0.82) for positive Prox UC. Uropathogen persistence was better identified when using 90PreOp UC (27%) than using PreOp UC (12%). We suggest reviewing UCs taken within 90 days preoperatively as this was found superior to a single preoperative midstream UCs in predicting postoperative infectious sequela after stone procedure.
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Affiliation(s)
- Matan Mekayten
- Department of Urology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Yishai Sompolinsky
- Obstetrics and Gynecology Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Amitay Lorber
- Department of Urology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mordechai Duvdevani
- Department of Urology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jacob Strahilevitz
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel.
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Mazzon G, Choong S, Celia A. Stone-scoring systems for predicting complications in percutaneous nephrolithotomy: A systematic review of the literature. Asian J Urol 2023. [PMID: 37538152 PMCID: PMC10394284 DOI: 10.1016/j.ajur.2023.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Objective Percutaneous nephrolithotomy is a treatment of choice for larger stones of the upper urinary tract. Currently, several nephrolithometric nomograms for prediction of post-operative surgical outcomes have been proposed, although uncertainties still exist regarding their roles in the estimation of complications. Methods We conducted a systematic review on PubMed and Web of Sciences databases including English studies with at least 100 cases and published between January 2010 and December 2021. We identified original articles evaluating correlations between the Guy's stone score, the stone size (S), tract length (T), obstruction (O), number of involved calices (N), and essence or stone density (E) (S.T.O.N.E.), Clinical Research Office of the Endourological Society (CROES), and Seoul National University Renal Stone Complexity (S-ReSC) scores and post-operative complications in adult patients. We also included newly designed nomograms for prediction of specific complications. Results After an initial search of 549 abstracts, we finally included a total of 18 papers. Of them, 11 investigated traditional nephrolithometric nomograms, while seven newly designed nomograms were used to predict specific complications. Overall, 7316 patients have been involved. In total, 14 out of 18 papers are derived from retrospective single-center studies. Guy's stone score obtained correlation with complications in five, S.T.O.N.E. nephrolithometry score in four, while CROES score and S-ReSC score in three and two, respectively. None of the studies investigated minimally invasive percutaneous nephrolithotomy (PCNL) and all cases have been conducted in prone position. Considering newly designed nomograms, none of them is currently externally validated; five of them predict post-operative infections; the remaining two have been designed for thromboembolic events and urinary leakage. Conclusion This review presents all nomograms currently available in the PCNL field and highlights a certain number of concerns. Published data have appeared contradictory; more recent tools for prediction of post-operative complications are frequently based on small retrospective cohorts and lack external validations. Heterogeneity among studies has also been noticed. More rigorous validations are advisable in the future, involving larger prospective patients' series and with the comparison of different tools.
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Obstructing Ureteral Calculi and Presumed Infection: Impact of Antimicrobial Duration and Time From Decompression to Stone Treatment in Developing Urosepsis. Urology 2023; 172:55-60. [PMID: 36334770 DOI: 10.1016/j.urology.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/13/2022] [Accepted: 10/12/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether the duration of antibiotic treatment and timing between urgent renal decompression and stone intervention impacts the risk of developing urosepsis following definitive stone treatment. MATERIALS & METHODS A retrospective review of patients who were diagnosed with obstructive urolithiasis and underwent urgent decompression with a ureteral double J stent or percutaneous nephrostomy at our institution between 2012 and 2018 was performed. We narrowed our analysis to the subset of patients who had suspected infection and received definitive stone treatment at our institution. Demographic, infection and antimicrobial data, and initial admission to stone treatment characteristics were collected. Factors associated with developing urosepsis were analyzed. RESULTS We identified 872 patients who were treated with urgent renal decompression, of which 215 were analyzed that had suspected infection and also received definitive stone removal at our institution. Thirty-three had fevers, 64.2% had a positive urine culture, and 45.6% had urosepsis at the initial presentation. The median antibiotics duration post decompression was 13 days (IQR 8-18). The median duration from decompression to stone treatment was 17 days (IQR 12-27). Of all, 4.6% of the patients developed urosepsis post ureteroscopy and 5% post percutaneous nephrolithotomy. No factors were associated with developing urosepsis post stone treatment on logistic regression analyses. CONCLUSION In patients requiring urgent decompression for obstructing urolithiasis and suspected infection, the time between decompression and stone treatment and the length of antibiotic exposure did not impact rates of postoperative urosepsis. This highlights the importance of maintaining high clinical suspicion for prolonged use of antibiotics, to prevent overtreatment and possible exacerbation of antibiotic resistance.
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Puia D, Gheorghincă Ş, Radavoi GD, Jinga V, Pricop C. Can we identify the risk factors for SIRS/sepsis after percutaneous nephrolithotomy? A meta‑analysis and literature review. Exp Ther Med 2023; 25:110. [PMID: 36793328 PMCID: PMC9923362 DOI: 10.3892/etm.2023.11809] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023] Open
Abstract
With the increase in percutaneous interventions such as percutaneous nephrolithotomy (PCNL) for renal lithiasis, infectious complications are becoming more frequent. The present study performed a systematic Medline and Embase databases search, using the following words: 'PCNL' [MeSH Terms] AND ['sepsis' (All Fields) OR 'PCNL' (All Fields)] AND ['septic shock' (All Fields)] AND ['urosepsis' (MeSH Terms) OR 'Systemic inflammatory response syndrome (SIRS)' (All Fields)]. Because of the technological advances in endourology, articles published between 2012 and 2022 were searched. Of the 1,403 results of the search, only 18 articles, representing 7,507 patients in which PCNL was performed, met the criteria to be included in the analysis. All authors applied antibiotic prophylaxis to all patients and, in some cases, the infection was treated preoperatively in those with positive urine cultures. According to the analysis of the present study, the operative time has been significantly longer in patients who developed SIRS/sepsis post-operatively (P=0.0001) with the highest heterogeneity (I2=91%) compared with other factors. Patients with a positive preoperative urine culture had a significantly higher risk of developing SIRS/sepsis following PCNL (P=0.00001), OD=2.92 (1.82, 4.68) and there was also a high degree of heterogeneity (I2=80%). Performing a multi-tract PCNL also increased the incidence of postoperative SIRS/sepsis (P=0.00001), OD=2.64 (1.78, 3.93) and the heterogeneity was a little smaller (I2=67%). Diabetes mellitus (P=0.004), OD=1.50 (1.14, 1.98), I2=27% and preoperative pyuria (P=0.002), OD=1.75 (1.23, 2.49), I2=20%, were other factors that significantly influenced postoperative evolution. A total of two factors analyzed, body mass index and patient's age, did not influence the outcome, P=0.45, I2=58% and P=0.98, I2=63%.
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Affiliation(s)
- Dragoş Puia
- Department of Urology, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iași, Romania,Department of Urology, C. I. Parhon Hospital, 700503 Iași, Romania
| | - Ştefan Gheorghincă
- Department of Urology, Neamţ Emergency County Hospital, 610136 Piatra Neamt, Romania,Correspondence to: Dr Ştefan Gheorghincă, Department of Urology, Neamţ Emergency County Hospital, 1-3 Traian Bulevardul, 610136 Piatra Neamt, Romania
| | - George Daniel Radavoi
- Department of Urology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania,Department of Urology, Prof. Dr. Theodor Burghele Clinical Hospital, 050653 Bucharest, Romania
| | - Viorel Jinga
- Department of Urology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania,Department of Urology, Prof. Dr. Theodor Burghele Clinical Hospital, 050653 Bucharest, Romania
| | - Cătălin Pricop
- Department of Urology, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iași, Romania,Department of Urology, C. I. Parhon Hospital, 700503 Iași, Romania
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Noviardi DEPP, Zuhirman, Jaya I, Afdal, Pitoyo J, Yashar MA, David NI. Preoperative inflammatory biomarkers analysis in prognosis of systemic inflammatory response syndrome following percutaneous nephrolithotomy: A systematic review and meta-analysis. Arab J Urol 2022. [DOI: 10.1080/2090598x.2022.2138891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
| | - Zuhirman
- Department of Surgery, Urology Sub-Division, Faculty of Medicine, Riau University, Pekanbaru, Indonesia
| | - Indra Jaya
- Department of Surgery, Urology Sub-Division, Faculty of Medicine, Riau University, Pekanbaru, Indonesia
| | - Afdal
- Department of Surgery, Urology Sub-Division, Faculty of Medicine, Riau University, Pekanbaru, Indonesia
| | - Joko Pitoyo
- Department of Surgery, Urology Sub-Division, Faculty of Medicine, Riau University, Pekanbaru, Indonesia
| | - Muhammad A. Yashar
- Department of Surgery, Urology Sub-Division, Faculty of Medicine, Riau University, Pekanbaru, Indonesia
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Yap LC, Hogan D, Patterson K, McGuinness G, O'Connor C, Sharfi A, Hennessey DB. Intrarenal pressures during percutaneous nephrolithotomy: a porcine kidney model. Scand J Urol 2022; 56:251-254. [PMID: 35546115 DOI: 10.1080/21681805.2022.2073387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Increased intrarenal pressure during endoscopic lithotripsy is associated with increased adverse outcomes. The objective of this study was to evaluate the effect of various devices on IRP during percutaneous intrarenal surgery in ex vivo porcine kidney models. METHODS Whole intact porcine urinary tracts were harvested. Intrarenal pressure was measured using cystometrometry software. Intrarenal pressure during PCNL was recorded using variations of percutaneous access sheath size, irrigation height of 100 cm and 60 cm, use of a ureteric catheter and use of suction. The primary outcome was absolute IRP measurements. Secondary outcomes were comparisons of IRP between techniques. RESULTS Using a 30 Fr vs 26 Fr access sheath and 26 Fr nephroscope the mean pressure at an irrigation height of 60 cm was significantly lower than 100 cm (p = 0.0013 vs p < 0.0001, respectively). Pressure's during mini-PCNL were significantly higher than conventional PCNL in all variations. Using the 16.5 Fr access sheath and 12 Fr nephroscope produced a significantly lower pressure at a 60 cm irrigation height than 100 cm (p = 0.0010). IRP was significantly lower with a ureteric catheter in place vs no ureteric catheter at 100 cm (p = 0.0015) and at 60 cm (p = 0.0040). CONCLUSIONS Using standard PCNL tract sizes intrarenal pressure varied significantly depending on the height of the irrigation fluid. Mini-PCNL is at higher risk of pathological pressure, however, the use of a ureteric catheter significantly decreased pressure. To maintain safe IRP during PCNL urologists should be aware of these significant variations.
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Affiliation(s)
- Lee Chien Yap
- Department of Urology, Mercy University Hospital, Cork, Ireland
| | - Donnacha Hogan
- Department of Urology, Mercy University Hospital, Cork, Ireland
| | | | | | | | - Ashraf Sharfi
- Department of Urology, Mercy University Hospital, Cork, Ireland
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Gao M, Zhu Z, Liu M, Chen J, Chen H. Predictive accuracy of the modified SOFA score, SIRS criteria, and qSOFA score for uroseptic shock after mini-percutaneous nephrolithotomy. Urolithiasis 2022; 50:455-464. [PMID: 35201365 DOI: 10.1007/s00240-022-01318-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/11/2022] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to determine the plausibility and utility of utilizing a modified SOFA (mSOFA) score for predicting uroseptic shock after mini-percutaneous nephrolithotomy. A cohort of 707 patients who received mini-PCNL from August 2019 to December 2020 was retrospectively evaluated. The area under receiver operating characteristic curve (AUROC) was used to compare the predictive value of septic shock between mSOFA, systemic inflammatory response syndrome (SIRS) and qSOFA. Among 707 patients, 24 patients experienced uroseptic shock after mini-PCNL. Compared with the no uroseptic shock group, the proportion of females and rates of preoperative urine culture, renal pelvis urine culture and stone culture positivity were higher in the uroseptic shock group, with high levels of preoperative C-reactive protein (CRP) and postoperative procalcitonin (PCT). In the uroseptic shock group, the mSOFA score increased by two or more points in 83.3%; 79.2% had at least two SIRS criteria, and 100% had a qSOFA score of at least one point. mSOFA score (AUROC = 0.866, 95% CI: 0.779-0.954) exhibited greater discrimination for uroseptic shock after PCNL than SIRS (AUROC = 0.838, 95% CI: 0.742-0.943) and qSOFA (AUROC = 0.851, 95% CI: 0.811-0.892). In conclusion, the predictive value of the modified SOFA score for uroseptic shock after mini-PCNL was greater than that of the qSOFA score or SIRS.
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Affiliation(s)
- Meng Gao
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zewu Zhu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Minghui Liu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Jinbo Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
| | - Hequn Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
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Kone K, Mallikarjun NT, Philipraj J. Dilute povidone-iodine irrigation during percutaneous nephrolithotomy to reduce postoperative infective complications - Is there any benefit? Urol Ann 2022; 14:353-358. [PMID: 36505996 PMCID: PMC9731197 DOI: 10.4103/ua.ua_111_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/27/2021] [Accepted: 11/23/2021] [Indexed: 12/15/2022] Open
Abstract
Background and Objective Infectious complications following stone lithotripsy is a significant source of patient morbidity and mortality. Post percutaneous nephrolithotomy fever is reported in 37% of patients undergoing PCNL and sepsis is the most common cause of mortality following PCNL. Thus, there is an urgent need to tackle lithotripsy-associated bacteremia occurring intraoperatively, keeping in mind the threat of emerging global antibiotic resistance. The aim of our study was to study the efficacy of using intermittent 0.35% dilute Povidone-Iodine (PI) irrigation during PCNL in reducing postoperative infection rate. Materials and Methods This is a prospective observational study done in 24 patients diagnosed with Staghorn and matrix calculi requiring PCNL. All patients were taken up for the procedure with sterile urine culture or after treating them with culture-specific antibiotic with initial positive urine culture. Intraoperative pelvic urine was sent for culture and sensitivity. 0.35% dilute PI irrigation was used intermittently during the procedure. Patients were monitored and assessed for signs of post-PCNL infection and PI-related side effects. The results were compared with similar group of patients with similar stone characteristics who underwent PCNL before adopting the dilute PI irrigation protocol (non-PI irrigation group). Results Among 24 patients, 18 patients had partial or complete Staghorn and 6 had matrix calculi. Five patients with Staghorn and three patients with matrix calculi had positive renal pelvic urine culture. In the non-PI irrigation group, 19 patients had Staghorn stones and 5 had matrix calculi. Three patients with Staghorn and two patients with matrix calculi had positive renal pelvic urine culture. Three patients (12.5%) had postoperative fever in the dilute PI irrigation group, compared to 11 patients (45.8%) in the non-PI irrigation group. No patient had PI-related complications. Conclusion Our prospective study highlights that the use of 0.35% dilute PI irrigation intermittently during PCNL reduces the postoperative infection rate significantly.
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Affiliation(s)
- Kalyanaram Kone
- Department of Urology, Mahatma Gandhi Medical College, Puducherry, India
| | - Naveen Thimiri Mallikarjun
- Department of Urology, Mahatma Gandhi Medical College, Puducherry, India,Address for correspondence: Dr. Naveen Thimiri Mallikarjun, 7/77, AH Block, 5th Street, Anna Nagar, Chennai - 600 040, Tamil Nadu, India. E-mail:
| | - Joseph Philipraj
- Department of Urology, Mahatma Gandhi Medical College, Puducherry, India
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12
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Demirelli E, Öğreden E, Bayraktar C, Tosun A, Oğuz U. The effect of perirenal fat stranding on infectious complications after ureterorenoscopy in patients with ureteral calculi. Asian J Urol 2021; 9:307-312. [PMID: 36035336 PMCID: PMC9399543 DOI: 10.1016/j.ajur.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/27/2021] [Accepted: 07/13/2021] [Indexed: 12/05/2022] Open
Abstract
Objective Perirenal fat stranding (PFS) is linear areas of soft-tissue attenuation in the perirenal space on non-contrast computed tomography. The present study aimed to investigate whether PFS is associated with infectious complications after ureterorenoscopy (URS) in patients with ureteral calculi in any location. Methods The data of 602 patients with ureteral stones who underwent URS were analyzed retrospectively. The patients were divided into two groups as Group 1 (PFS not detected) and Group 2 (PFS detected). Gender, and age of patients, size, side, and location of the stone, operation time, double-J stent insertion status, perioperative ureter injury, postoperative infection after URS and related complications, and duration of hospital stay were compared. Results While PFS was not detected in 530 patients, PFS was detected in 72 patients. The mean age, male/female ratio, side and localization of the stones, operation time, and perioperative insertion of the double-J after lithotripsy were statistically similar (p>0.05). The median stone diameter was smaller in Group 2 (9 mm vs. 8 mm) (p=0.033). Fever was observed in 30 and 38 patients in Group 1 and Group 2, respectively (p=0.0001). Urinary tract infection was detected in 24 and 27 patients in Group 1 and Group 2, respectively (p=0.0001). The urosepsis did not occur in any patients in Group 1, whereas 8 (11.1%) patients in Group 2 experienced urosepsis (p=0.0001). Conclusion According to the results of the present study, patients with ureteral stones accompanied by PFS are much more prone to ureteral injuries and infectious complications such as urinary tract infection, fever, and sepsis after URS.
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Affiliation(s)
- Erhan Demirelli
- Giresun University, Faculty of Medicine, Department of Urology, Giresun, Turkey
- Corresponding author.
| | - Ercan Öğreden
- Giresun University, Faculty of Medicine, Department of Urology, Giresun, Turkey
| | - Cemil Bayraktar
- Ministry of Health, Kayseri City Hospital, Department of Urology, Kayseri, Turkey
| | - Alptekin Tosun
- Giresun University, Faculty of Medicine, Department of Radiology, Giresun, Turkey
| | - Ural Oğuz
- Giresun University, Faculty of Medicine, Department of Urology, Giresun, Turkey
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13
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Amier Y, Zhang Y, Zhang J, Yao W, Wang S, Wei C, Yu X. Analysis of pre-operative risk factors for post-operative urosepsis following mini-percutaneous nephrolithotomy in patients with large kidney stones. J Endourol 2021; 36:292-297. [PMID: 34569289 DOI: 10.1089/end.2021.0406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To assess the pre-operative risk factors for post-operative urosepsis following mini-percutaneous nephrolithotomy (mPCNL) in patients with large kidney stones. Methods:Records of 171 patients with large (≥30mm) kidney stones who underwent mPCNL from December 2013 to October 2019 were reviewed. Demographic data of patients, pre-operative urine analysis, urine culture, routine blood tests and abdominal computerized cosmography data were collected and analyzed. A predictive nomogram model was established based on the results of logistic regression. RESULTS 29 patients (17%) developed post-operative urosepsis in this study. Univariate analysis demonstrated that preoperative urine leukocytes (P <0.001), urine nitrite (P <0.001), stones in adjacent calices on the coronal plane (P <0.001), the maximum cross-sectional area of stones (P <0.001), the diameter of hydronephrosis (P =0.010) and number of stones (P=0.044) were associated with post-operative urosepsis after mPCNL in patients with large kidney stones. And pre-operative urine leukocytes ≥450/ µl (P=0.002) was the only independent risk factor for post-operative urosepsis in multivariate logistic regression analysis. Based on the results of multivariate regression, a nomogram model was established for the prediction of post-operative urosepsis with ideal discrimination (area under receiver operating characteristic curve was 0.867). CONCLUSION Patients with certain pre-operative characteristics, including higher urine leukocytes, positive urine nitrite, stones in adjacent calices on the coronal plane, larger maximum cross-sectional area of stones, larger diameter of hydronephrosis and larger number of stones, who received mPCNL may have a higher risk of postoperative urosepsis. A predictive model can help urologists identify patients who may develop post-operative urosepsis with high probability.
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Affiliation(s)
- Yirixiatijiang Amier
- Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 66375, Urology, Wuhan, China;
| | - Yucong Zhang
- Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 66375, Urology, Wuhan, Hubei , China;
| | - Jiaqiao Zhang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Urology, 1095 Jiefang Ave., Wuhan, Wuhan, Hubei , China, 430030;
| | - Weimin Yao
- Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 66375, Urology, Wuhan, China;
| | - Shaogang Wang
- Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 66375, Urology, 1095#, Jiefang Avenue, Wuhan, China, 430030;
| | | | - Xiao Yu
- Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 66375, Urology, No. 1095, Jiefang Avenue, Wuhan, China, 430030;
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14
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Purwar R, Thirugnanasambandam V, Mossadeq A. A randomized study comparing conventional percutaneous nephrolithotomy versus check pyeloscopic percutaneous nephrolithotomy. Urol Ann 2021; 13:232-237. [PMID: 34421257 PMCID: PMC8343295 DOI: 10.4103/ua.ua_26_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 12/30/2020] [Indexed: 11/04/2022] Open
Abstract
Objective The objective of this study is to compare the advantages of check-pyeloscopic percutaneous nephrolithotomy (CP-PCNL) over conventional PCNL (C-PCNL) in the management of renal calculi. Materials and Methods All patients with renal calculi requiring PCNL who attended the department of urology in a tertiary care center from December 2016 to October 2018 were included in the study. The patients were randomized into two groups of 50 each. Each group underwent PCNL in a conventional or check pyeloscopic method, respectively. Results A total number of complications were more in C-PCNL group comprising of two pelvic tears, 8 infundibular tears, 1 minor urothelial injury, 2 cases of bleeding lasting for more than 24 hours, while in CP-PCNL group, complications were less (comprising of 1 minor urothelial injury and 1 case of infundibular tear). Statistical analysis was used to compare both the groups, and the results were statistically significant (P = 0.027). Conclusion Check pyeloscopy at the time of PCNL is a safe, effective, and economical technique. This study shows that the complications such as blood loss, urothelial injury, and postoperative pain are less when check pyeloscopy is done during PCNL.
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Affiliation(s)
- Rohit Purwar
- Department of Urology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pondicherry, India
| | - Vasudevan Thirugnanasambandam
- Department of Urology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pondicherry, India
| | - Abdulrazack Mossadeq
- Department of Urology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pondicherry, India
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15
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Yu Y, Pu J, Wu T, Hu L. The characteristics and influencing factors of fever in postoperative patients undergoing percutaneous nephrolithotomy: A retrospective analysis. Medicine (Baltimore) 2021; 100:e26485. [PMID: 34397870 PMCID: PMC8360468 DOI: 10.1097/md.0000000000026485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/28/2021] [Indexed: 01/04/2023] Open
Abstract
Percutaneous nephrolithotomy (PCNL) is commonly used for the treatment of upper urinary calculi in clinical setting, and fever is a common complication after PCNL. It is necessary to evaluate the risk factors of fever in patients undergoing PCNL, to provide insights into the management of PCNL.Patients who underwent PCNL in our hospital from January 2018 to August 2020 were included. The clinical data of postoperative fever and no fever patients were collected and assessed. Logistic regression analyses were conducted to analyze the risk factors for fever in patients undergoing PCNL.A total of 276 patients undergoing PCNL were included, the incidence of postoperative fever for patients undergoing PCNL was 19.39%. No significant differences in the gender, body mass index, alcohol drinking, smoking, hypertension, hyperlipidemia, intraoperative blood infusion, length of hospital stay between fever patients, and no fever patients were found (all P > .05). There were significant differences in the age, diabetes, size of stones, duration of surgery between fever patients, and no fever patients (all P < .05). Age ≥60 years (odds ratio [OR] 2.143, 95% confidence interval [CI] 1.101∼3.264), diabetes (OR 2.218, 95% CI 1.176∼4.642), size of stone ≥2 cm (OR 1.428, 95%CI 1.104∼2.055), duration of surgery ≥100 minutes (OR 1.334, 95% CI 1.015∼1.923) were the risk factors for fever in patients with PCNL (all P < .05). Escherichia coli (48.44%), Staphylococcus aureus (18.75%), and Candida albicans (10.93%) were the top 3 pathogenic bacteria of urine culture.Fever is one of the common complications after PCNL. Patients with high-risk factors should be given full attentions and take corresponding preventive measures targeted on risks.
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Teh KY, Tham TM. Predictors of post-percutaneous nephrolithotomy sepsis: The Northern Malaysian experience. Urol Ann 2021; 13:156-162. [PMID: 34194142 PMCID: PMC8210729 DOI: 10.4103/ua.ua_28_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 09/16/2020] [Indexed: 12/02/2022] Open
Abstract
Objectives: Percutaneous nephrolithotomy (PCNL) carries a small risk of postoperative sepsis due to the liberation of bacteria into the patients’ bloodstream during stone fragmentation. The study aims to identify the incidence of post-PCNL sepsis in our center, as well as to delineate perioperative characteristics associated with increased rates of sepsis. Materials and Methods: We performed a retrospective review on all PCNLs performed in our center between July 2012 and June 2017, with emphasis on preoperative urine results, intra-operative findings, and postoperative septic complications. Results: Among 425 cases of PCNL performed, 16 (3.76%) developed sepsis postoperatively. Patients with positive preoperative urine cultures were almost four times as likely to develop post-PCNL sepsis compared to those with negative cultures (8.41% vs. 2.2%, P = 0.004). Among patients with positive urine leukocytes and positive urine cultures, the presence of Staghorn calculi and multiple PCNL punctures both predicted significantly higher risks of postoperative sepsis. In contrast, diabetes mellitus and preoperative stenting were not found to be associated with a greater risk of post-PCNL sepsis. Conclusions: Patients who had positive preoperative urine leukocytes and/or cultures, and either harbor Staghorn calculi or are deemed to require more than one puncture on PCNL, were at an increased risk of developing post-PCNL sepsis. Such at-risk patients should be identified preoperatively, given aggressive perioperative antibiotic treatment, and monitored closely for septic complications during the convalescence period.
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Affiliation(s)
- Khai Yeong Teh
- Department of Urology, Selayang Hospital, Selangor, Malaysia
| | - Teck Meng Tham
- Department of Surgery (Urology), Johor Specialist Hospital, Johor, Malaysia
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Pillai S, Kriplani A, Chawla A, Somani B, Pandey A, Prabhu R, Choudhury A, Pandit S, Taori R, Hegde P. Acute Kidney Injury Post-Percutaneous Nephrolithotomy (PNL): Prospective Outcomes from a University Teaching Hospital. J Clin Med 2021; 10:1373. [PMID: 33805325 PMCID: PMC8037383 DOI: 10.3390/jcm10071373] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/03/2021] [Accepted: 03/11/2021] [Indexed: 12/31/2022] Open
Abstract
Acute Kidney Injury (AKI) after percutaneous nephrolithotomy (PNL) is a significant complication, but evidence on its incidence is bereft in the literature. The objective of this prospective observational study was to analyze the incidence of post-PNL AKI and the potential risk factors and outcomes. Demographic data collected included age, gender, body mass index (BMI), comorbidities (hypertension, diabetes mellitus), and drug history-particularly angiotensin converting enzyme inhibitors (ACE inhibitors), angiotensin II receptor blockers and beta blockers. Laboratory data included serial serum creatinine measured pre- and postoperation (12, 24, and 48 h), hemoglobin (Hb), total leucocyte count (TLC), Prothrombin time (PT), serum uric acid and urine culture. Stone factors were assessed by noncontrast computerized tomography of kidneys, ureter and bladder (NCCT KUB) and included stone burden, location and Hounsfield values. Intraoperative factors assessed were puncture site, tract size, tract number, operative time, the need for blood transfusion and stone clearance. Postoperative complications were documented using the modified Clavien-Dindo grading system and patients with postoperative AKI were followed up with serial creatinine measurements up to 1 year. Among the 509 patients analyzed, 47 (9.23%) developed postoperative AKI. Older patients, with associated hypertension and diabetes mellitus, those receiving ACE inhibitors and with lower preoperative hemoglobin and higher serum uric acid, had higher incidence of AKI. Higher stone volume and density, staghorn stones, multiple punctures and longer operative time were significantly associated with postoperative AKI. Patients with AKI had an increased length of hospital stay and 17% patients progressed to chronic kidney disease (CKD). Cut-off values for patient age (39.5 years), serum uric acid (4.05 mg/dL) and stone volume (673.06 mm3) were assessed by receiver operating characteristic (ROC) curve analysis. Highlighting the strong predictors of post-PNL AKI allows early identification, proper counseling and postoperative planning and management in an attempt to avoid further insult to the kidney.
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Affiliation(s)
- Sunil Pillai
- Department of Urology, Kasturba Medical College Hospital, Manipal Academy of Higher Education (MAHE), Manipal 576104, Karnataka, India; (S.P.); (A.K.); (R.P.); (A.C.); (S.P.); (R.T.); (P.H.)
| | - Akshay Kriplani
- Department of Urology, Kasturba Medical College Hospital, Manipal Academy of Higher Education (MAHE), Manipal 576104, Karnataka, India; (S.P.); (A.K.); (R.P.); (A.C.); (S.P.); (R.T.); (P.H.)
| | - Arun Chawla
- Department of Urology, Kasturba Medical College Hospital, Manipal Academy of Higher Education (MAHE), Manipal 576104, Karnataka, India; (S.P.); (A.K.); (R.P.); (A.C.); (S.P.); (R.T.); (P.H.)
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK;
| | - Akhilesh Pandey
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal 576104, Karnataka, India;
| | - Ravindra Prabhu
- Department of Urology, Kasturba Medical College Hospital, Manipal Academy of Higher Education (MAHE), Manipal 576104, Karnataka, India; (S.P.); (A.K.); (R.P.); (A.C.); (S.P.); (R.T.); (P.H.)
| | - Anupam Choudhury
- Department of Urology, Kasturba Medical College Hospital, Manipal Academy of Higher Education (MAHE), Manipal 576104, Karnataka, India; (S.P.); (A.K.); (R.P.); (A.C.); (S.P.); (R.T.); (P.H.)
| | - Shruti Pandit
- Department of Urology, Kasturba Medical College Hospital, Manipal Academy of Higher Education (MAHE), Manipal 576104, Karnataka, India; (S.P.); (A.K.); (R.P.); (A.C.); (S.P.); (R.T.); (P.H.)
| | - Ravi Taori
- Department of Urology, Kasturba Medical College Hospital, Manipal Academy of Higher Education (MAHE), Manipal 576104, Karnataka, India; (S.P.); (A.K.); (R.P.); (A.C.); (S.P.); (R.T.); (P.H.)
| | - Padmaraj Hegde
- Department of Urology, Kasturba Medical College Hospital, Manipal Academy of Higher Education (MAHE), Manipal 576104, Karnataka, India; (S.P.); (A.K.); (R.P.); (A.C.); (S.P.); (R.T.); (P.H.)
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18
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Antibiotic administration for negative midstream urine culture patients before percutaneous nephrolithotomy. Urolithiasis 2021; 49:505-512. [PMID: 33710365 DOI: 10.1007/s00240-021-01260-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
To investigate how to administrate antibiotics for negative midstream urine culture (UC-) patients prior to percutaneous nephrolithotomy (PCNL), we retrospectively analyzed UC-patients receiving 0 or 3 days of cefuroxime prior to PCNL between July 2017 and May 2020. Patients were further divided into four groups (Group1A = urine with positive both nitrite and white blood cell (N + WBC +) and 0-day pre-operative cefuroxime; Group1B = N + WBC + and 3-day cefuroxime; Group2A = N - WBC + and 0-day cefuroxime; Group2B = N - WBC + and 3-day cefuroxime). All patients routinely received a dose of cefuroxime 30 min prior to the surgery. In addition, Group1B were matched to the Group1A; Group2B were matched to the Group2A at a 1:1 ratio regarding stone burden, the degree of hydronephrosis, stone hardness, age and sex in a sequential order. A total of 560 patients were included (Group1A = 72; Group1B = 72; Group2A = 208; Group2B = 208). The baseline characteristics were equally distributed between the matched-pair groups. Compared to Group1B, Group1A had a significantly higher incidence of SIRS, fever, urosepsis requiring only additional antibiotics, and an increased postoperative hospitalization stay. Compared to Group2B, Group2A had similar rate of infectious complications. In addition, Group1B was associated with a significantly lower rate of positive pelvic urine culture (PUC +) than that of Group1A; whereas, there was similar rate of PUC + between Group2A and Group2B. UC-patients with N + WBC + should be treated with extended period of antibiotic administration, and a single dose of prophylactic antibiotic was sufficient for UC-patients with N - WBC + prior to PCNL. Despite UC, it is suggested to stratify pre-operative antibiotics tailored to individual patients to optimize its application.
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19
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Chan JY, Wong VK, Wong J, Paterson RF, Lange D, Chew BH, Scotland KB. Predictors of urosepsis in struvite stone patients after percutaneous nephrolithotomy. Investig Clin Urol 2021; 62:201-209. [PMID: 33660448 PMCID: PMC7940850 DOI: 10.4111/icu.20200319] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/10/2020] [Accepted: 11/18/2020] [Indexed: 01/14/2023] Open
Abstract
Purpose This study aims to identify clinical factors that may predispose struvite stone patients to urosepsis following percutaneous nephrolithotomy (PCNL). Materials and Methods A retrospective review was conducted on patients who received PCNL for struvite stones. The Systemic Inflammatory Response Syndrome (SIRS) criteria and quick-Sepsis Related Organ Failure Assessment (q-SOFA) criteria were used to identify patients who were at an increased risk for urosepsis. Statistical analysis was performed using Fisher's exactness test, Wilcoxon rank test, and logistic regression. Results Chart review identified 99 struvite stone patients treated with PCNL. Post-operatively, 40 patients were SIRS positive (≥2 criteria) and/or q-SOFA positive (score ≥2). Using SIRS as an approximation for urosepsis, longer operative times (p<0.001), higher pre-operative white blood cell counts (p=0.01), greater total stone surface area (p<0.0001), and pre-operative stenting (OR, 5.75; p=0.01) were identified as independent risk factors for urosepsis. Multivariate analysis demonstrated pre-operative stenting (OR, 1.46; p=0.01) to be a risk factor. With q-SOFA, univariable analysis found that antibiotic use within 3 months prior to a PCNL (OR, 4.44; p=0.04), medical comorbidities (OR, 4.80; p=0.02), longer operative times (p<0.001), lengthier post-operative hospitalization (p<0.01), and greater total stone surface area (p<0.0001) were risk factors for urosepsis. Multivariate analysis revealed that bladder outlet obstruction (OR, 2.74; p<0.003) and pre-operative stenting (OR, 1.27; p=0.01) significantly increased odds of being q-SOFA positive. Conclusions Several risk factors for urosepsis following PCNL for struvite stones have been identified. These risk factors should be taken into consideration in peri-operative care to mitigate the risks of urosepsis.
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Affiliation(s)
- Justin Yh Chan
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Victor Kf Wong
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Julie Wong
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Ryan F Paterson
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Dirk Lange
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Ben H Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Kymora B Scotland
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.,Department of Urology, University of California, Los Angeles, CA, USA.
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Khori FA, Al-Naser MM, Al-Majali AS, Al-Serhan MA, Al-Kaabneh AB, Ni'mate AS, Al-Qaralleh AA, Alrababaah AM, Al-Jfout SG, Al-Saidah NJ, Al-Asmer AA, Al-Khawaldah BA, Alemoush MA, Al-Hjazeen AA. The impact of nephrostomy balloon inflation volume on post percutaneous nephrolithotomy hemorrhage. Pan Afr Med J 2020; 36:384. [PMID: 33235661 PMCID: PMC7666690 DOI: 10.11604/pamj.2020.36.384.25162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/11/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction the study aims to match different volumes of nephrostomy balloon inflation to point out the foremost effective volume size of post percutaneous nephrolithotomy (PCNL) bleeding control. Methods we have retrospectively reviewed “560” medical records of patients who underwent percutaneous nephrolithotomy between (the years 2017 and 2018) at Prince Hussein Urology Center. The Patients were divided into two teams, group-1 (a number of 280 patients) with nephrostomy balloon inflated concerning three ml and group-2 (a number of 280 patients) the balloon inflated concerning one ml. The preoperative and postoperative hematocrit, the operation duration, the stone size, the postoperative pain severity, the transfusion rate and the duration of hematuria between the two groups were compared during hospitalization. Results regarding patients with ages (between 18 and 68 years); the preoperative hematocrit (mean values ± SDs) was (40.35% ± 3.57) vs (39.95% ± 3.43) for groups-1 and 2, respectively; the p value=0.066. The postoperative hematocrit was (37.91% ± 3.96) vs (34.38 ± 2.78), respectively; the p value was (0.008); the blood transfusion rate was 11.2% vs 13.4% (the p value was 0.039), respectively. The Postoperative pain score was (4.93 ± 1.44) vs (3.89 ± 1.45) (the p value was 0.012), respectively. Conclusion increasing the nephrostomy balloon volume to a “3cc” competes for a task to decrease bleeding which was found to be as a secure and considerable effective procedure-related factor. However, the disadvantage of this technique resulted in increasing the postoperative pain in patients undergoing such a procedure.
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Affiliation(s)
- Firas Azar Khori
- The Prince Hussein Urology Institute (PHUI), The King Hussein Medical Centre, (KHMC), Amman, Jordan
| | - Mohannad Mueen Al-Naser
- The Prince Hussein Urology Institute (PHUI), The King Hussein Medical Centre, (KHMC), Amman, Jordan
| | | | | | - Awad Bakheet Al-Kaabneh
- The Prince Hussein Urology Institute (PHUI), The King Hussein Medical Centre, (KHMC), Amman, Jordan
| | - Abdelhakim Saleh Ni'mate
- The Prince Hussein Urology Institute (PHUI), The King Hussein Medical Centre, (KHMC), Amman, Jordan
| | - Ayman Ahmad Al-Qaralleh
- The Prince Hussein Urology Institute (PHUI), The King Hussein Medical Centre, (KHMC), Amman, Jordan
| | | | - Samer Gaith Al-Jfout
- Interventional Radiology (IR), The King Hussein Medical Centre, (KHMC), Amman, Jordan
| | - Nizar Jamal Al-Saidah
- The Prince Hussein Urology Institute (PHUI), The King Hussein Medical Centre, (KHMC), Amman, Jordan
| | - Ali Ahmad Al-Asmer
- The Prince Hussein Urology Institute (PHUI), The King Hussein Medical Centre, (KHMC), Amman, Jordan
| | | | - Monther Ata Alemoush
- The Prince Hussein Urology Institute (PHUI), The King Hussein Medical Centre, (KHMC), Amman, Jordan
| | - Anees Adel Al-Hjazeen
- The Prince Hussein Urology Institute (PHUI), The King Hussein Medical Centre, (KHMC), Amman, Jordan
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21
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Xun Y, Yang Y, Yu X, Li C, Lu J, Wang S. A preoperative nomogram for sepsis in percutaneous nephrolithotomy treating solitary, unilateral and proximal ureteral stones. PeerJ 2020; 8:e9435. [PMID: 32655994 PMCID: PMC7331651 DOI: 10.7717/peerj.9435] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/06/2020] [Indexed: 12/12/2022] Open
Abstract
Background Postoperative sepsis is a lethal complication for percutaneous nephrolithotomy (PCNL). An early predictive model combined local and systemic conditions is urgently needed to predict infectious events. We aim to determine the preoperative predictors of sepsis after PCNL in patients with unilateral, solitary, and proximal ureteral stones. Methods A total of 745 patients who underwent PCNL between January 2012 and December 2018 were retrospectively enrolled. Sepsis was defined based on the International Sepsis Definitions in 2001, and the preoperative factors were compared between the non-sepsis and sepsis groups. Univariable analysis and multivariable logistic regression analysis were conducted to determine the predictors for sepsis after PCNL. A nomogram was generated using the predictors. Results In this study, 35 patients (4.7%) developed sepsis after PCNL. Univariate analysis showed that post-PCNL sepsis was associated with the female, lower albumin, higher globulin, lower albumin globulin ratio (AGR < 1.5), preoperative fever, leukocytosis (WBC ≥ 10,000 cells/μL), positive urine culture, leukocyturia (≥50 cells/μL) and positive urine nitrite. Multivariate logistic regression analysis suggested that AGR < 1.5 (odds ratio [OR] = 5.068, 95% confidence interval [CI] [1.135-22.624], P = 0.033), positive urine culture (OR = 3.243, 95% CI [1.162-9.047], P = 0.025), leukocytosis (OR = 3.706, 95% CI [1.444-9.512], P = 0.006) and female (OR = 2.529, 95% CI [1.127-5.672], P = 0.024) were independent risk factors for sepsis. A nomogram was generated and displayed favorable fitting (Hosmer-Lemeshow test P = 0.797), discrimination (area under receiver operating characteristic curve was 0.807), and clinical usefulness by decision curve analysis. Conclusions Patients with certain preoperative characteristics, such as female, lower AGR, positive urine culture, and leukocytosis, who undergo PCNL may have a higher risk of developing sepsis. A cautious preoperative evaluation and optimized treatment strategy should be considered in these patients to minimize infectious complications.
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Affiliation(s)
- Yang Xun
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanyuan Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao Yu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cong Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junlin Lu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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22
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Glybochko PV, Alyaev YG, Rudenko VI, Rapoport LM, Grigoryan VA, Butnaru DV, Perekalina AN, Kraev IG, Korolev DO. The clinical role of X-ray computed tomography to predict the clinical efficiency of extracorporeal shock wave lithotripsy. Urologia 2019; 86:63-68. [PMID: 31179884 DOI: 10.1177/0391560317749422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM To evaluate the clinical efficiency of computed tomography for diagnostics of patients with urolithiasis and the choice of treatment strategy. MATERIAL AND METHODS The study was carried out at the Urological Clinic of I.M. Sechenov First Moscow State Medical University and included 1044 patients with urinary stones. The ultimate goal of this study was to predict the clinical efficiency of extracorporeal shock wave lithotripsy using a combination of computed tomography and densitometry. Extracorporeal shock wave lithotripsy was performed on "Siemens Lithostar Plus," "Siemens Modularis Uro," and "Dornier Gemini" lithotripters. Statistical analysis of clinical data included evaluation of individual sampling groups and calculation of weighted arithmetic mean ( M). RESULTS The efficiency of extracorporeal shock wave lithotripsy has been determined primarily using X-ray analysis of the concrement outlines and the structure (homogeneous or heterogeneous) of its central zone. However, in terms of efficiency and repetition rate (the number of fragmentation procedures required for complete clearance) of extracorporeal shock wave lithotripsy, the mean density of the concrement along the whole length of its three-dimensional structure (expressed in Hounsfield units) appeared to be the most reliable and informative predictive index in this study. CONCLUSION The combination of computed tomography with densitometry in the treatment of patients with urolithiasis allows one (1) to determine the exact localization, size, X-ray structure, and structural density of urinary stones and (2) to predict, on the basis of densitometric data histograms, the clinical efficiency and repetition rate of extracorporeal shock wave lithotripsy with due regard to the X-ray structure of peripheral and central zones, and mean density (in Hounsfield units) of urinary concrements.
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Affiliation(s)
- Peter Vitalevich Glybochko
- 1 I.M. Sechenov First Moscow State Medical University, Moscow, Russia.,2 Research Institute of Uronephrology and Human Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Yuri Gennadevich Alyaev
- 3 Department of Urology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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Xu H, Hu L, Wei X, Niu J, Gao Y, He J, Hou J. The Predictive Value of Preoperative High-Sensitive C-Reactive Protein/Albumin Ratio in Systemic Inflammatory Response Syndrome After Percutaneous Nephrolithotomy. J Endourol 2018; 33:1-8. [PMID: 30430854 DOI: 10.1089/end.2018.0632] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The aim of the study was to evaluate the predictive value of preoperative high-sensitive C-reactive protein/albumin (hs-CRP/Alb) ratio in systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS We retrospectively reviewed 556 patients who underwent PCNL at our institution between August 2015 and February 2018. The primary endpoint for the study was the development of SIRS after operation. A univariate and multivariate logistic regression analysis was used to identify the independent factors associated with the post-PCNL SIRS. Receiver operating characteristic (ROC) curves were constructed and the areas under the curve (AUC) were calculated to compare the discriminatory ability of systemic inflammation biomarkers. RESULTS Among the 556 patients who underwent PCNL, 123 patients (22.1%) developed SIRS. Multivariate analysis revealed that female gender (OR 1.691; 95% CI 1.045-2.735; p = 0.032), positive urine culture (OR 1.972; 95% CI 1.204-3.231; p < 0.01), hs-CRP/Alb ratio (OR 6.925; 95% CI 4.244-11.300; p < 0.01), neutrophil to lymphocyte ratio (NLR) (OR 2.476; 95% CI 1.471-4.167; p < 0.01), and prognostic nutritional index (PNI) (OR 0.559; 95% CI 0.338-0.924; p = 0.023) were independent predictors of post-PCNL SIRS. The optimal cutoff value of the hs-CRP/Alb ratio was 0.06 from the ROC analysis. The elevated hs-CRP/Alb ratio was significantly associated with female gender, positive urine culture, hs-CRP, albumin, leukocyte, neutrophil, monocyte, platelet, hemoglobin, creatinine, NLR, lymphocyte to monocyte ratio (LMR), platelet to lymphocyte ratio (PLR), PNI, high-sensitive modified Glasgow prognostic score (hs-mGPS), development of sepsis, ICU admission, and length of stay (all p < 0.05). In addition, the hs-CRP/Alb ratio had a higher AUC (0.791) with a sensitivity of 76.4% and a specificity of 73.2% than NLR (0.669), LMR (0.633), PLR (0.594), PNI (0.629), and hs-mGPS (0.739). CONCLUSIONS The preoperative hs-CRP/Alb ratio is independently predictive for the development of SIRS after PCNL. Moreover, compared with other systemic inflammation biomarkers, the preoperative hs-CRP/Alb ratio shows a better predictive value.
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Affiliation(s)
- Hongbo Xu
- 1 Department of Urology, The First Affiliated Hospital of Soochow University , Suzhou, P.R. China
| | - Linkun Hu
- 1 Department of Urology, The First Affiliated Hospital of Soochow University , Suzhou, P.R. China
| | - Xuedong Wei
- 1 Department of Urology, The First Affiliated Hospital of Soochow University , Suzhou, P.R. China
| | - Jian Niu
- 2 Center for Clinical Laboratory, The First Affiliated Hospital of Soochow University , Suzhou, P.R. China
| | - Yuanyuan Gao
- 2 Center for Clinical Laboratory, The First Affiliated Hospital of Soochow University , Suzhou, P.R. China
| | - Jun He
- 2 Center for Clinical Laboratory, The First Affiliated Hospital of Soochow University , Suzhou, P.R. China
| | - Jianquan Hou
- 1 Department of Urology, The First Affiliated Hospital of Soochow University , Suzhou, P.R. China
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24
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Xu C, Feng S, Lin C, Zheng Y. Reducing postoperative morbidity of mini-invasive percutaneous nephrolithotomy: Would it help if blood vessels are left unharmed during puncture? A CONSORT-prospective randomized trial. Medicine (Baltimore) 2018; 97:e13314. [PMID: 30461644 PMCID: PMC6392735 DOI: 10.1097/md.0000000000013314] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The aim of this study was to provide a randomized controlled trial comparing single B-mode ultrasound guidance and color doppler ultrasound guidance in minimally invasive percutaneous nephrolithotomy. METHODS Three hundred patients with renal calculus were prospectively randomly assigned into 2 groups. In group 1 (150 patients), minimally invasive percutaneous nephrolithotomy (m-PCNL) were managed with single B-mode ultrasound guidance; In group 2 (150 patients), m-PCNL were managed with color Doppler ultrasound guidance and a needle bracket in order to guide placement at a target location beneath the skin. The characteristics of patients, operation, complications and prognosis, including body temperature, urine culture, and hematologic tests after the operation were recorded and compared. RESULTS Our vessel-sparing technique showed a statistically significant decrease in hemoglobin drop, postoperative procalcitonin values, the frequency of postoperative fever, systemic inflammatory response syndrome, and urosepsis (P < .05). CONCLUSION Using color Doppler ultrasound in real time and a needle bracket to detect and avoid main renal blood vessels decreased incidences of hemorrhagic complications and postoperative infection.
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Affiliation(s)
- Congcong Xu
- Department of Urology, The Second Affiliated Hospital of Zhejiang University School of Medicine
| | - Sheng Feng
- Department of Urology, The First Affiliated Hospital of Zhejiang Chinese Medical University
| | - Caixiu Lin
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yichun Zheng
- Department of Urology, The Second Affiliated Hospital of Zhejiang University School of Medicine
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25
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Kumar M, Pandey S, Aggarwal A, Sharma D, Garg G, Agarwal S, Sharma A, Sankhwar S. Unplanned 30-day readmission rates in patients undergoing endo-urological surgeries for upper urinary tract calculi. Investig Clin Urol 2018; 59:321-327. [PMID: 30182077 PMCID: PMC6121023 DOI: 10.4111/icu.2018.59.5.321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 08/16/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose To see the 30-day unplanned readmission rates in patients underdoing endo-urological surgeries for upper urinary tract calculi we conducted this retrospective study at King George's Medical University, Lucknow, India. Unplanned readmissions not only add to healthcare costs but also are bothersome for the patients. There are many studies on 30-day unplanned readmissions in general surgical patients. Although similar studies have been done in certain urological procedures, no study has reported readmission rates or its risk factors in patients undergoing surgeries for upper urinary tract calculi. Materials and Methods We retrospectively reviewed our prospectively maintained database from 1st January 2009 to 31st December 2017, for the patients who underwent endo-urological procedures for upper urinary tract calculi and identified the patients who were re-admitted within 30 days of discharge. Results Out of the total 3,209 patients undergoing endo-urological procedures for upper urinary tract calculi 56 were re-admitted. The readmission rate was 1.74% over the study period. The most common etiology for readmission was sepsis followed by hematuria. The significant risk factors for readmission in bivariate analysis included male gender, age >65 years, current smoking, chronic obstructive pulmonary disease, diabetes mellitus, bleeding disorder, prior cardiac disease, and American Society of Anesthesiologists (ASA) class ≥3. In multivariate risk adjusted logistic regression analysis ASA class ≥3 was the only independent risk factor for readmission. Conclusions The readmission rates in endo-urological procedures for urolithiasis are less compared to other procedures. ASA class ≥3 is the most important independent predictor of unplanned 30-day readmissions.
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Affiliation(s)
- Manoj Kumar
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Siddharth Pandey
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ajay Aggarwal
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Deepanshu Sharma
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Gaurav Garg
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Samarth Agarwal
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ashish Sharma
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Satyanarayan Sankhwar
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
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26
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Shi X, Peng Y, Li L, Li X, Wang Q, Zhang W, Dong H, Shen R, Lu C, Liu M, Gao X, Sun Y. Renal function changes after percutaneous nephrolithotomy in patients with renal calculi with a solitary kidney compared to bilateral kidneys. BJU Int 2018; 122:633-638. [PMID: 29802813 DOI: 10.1111/bju.14413] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Xiaolei Shi
- Department of Urology; Shanghai Changhai Hospital; Shanghai China
| | - Yonghan Peng
- Department of Urology; Shanghai Changhai Hospital; Shanghai China
| | - Ling Li
- Department of Urology; Shanghai Changhai Hospital; Shanghai China
| | - Xiao Li
- Department of Radiology; Shanghai Changhai Hospital; Shanghai China
| | - Qi Wang
- Department of Urology; Shanghai Changhai Hospital; Shanghai China
| | - Wei Zhang
- Department of Urology; Shanghai Changhai Hospital; Shanghai China
| | - Hao Dong
- Department of Urology; Shanghai Changhai Hospital; Shanghai China
| | - Rong Shen
- Department of Urology; Shanghai Changhai Hospital; Shanghai China
| | - Chaoyue Lu
- Department of Urology; Shanghai Changhai Hospital; Shanghai China
| | - Min Liu
- Department of Urology; Shanghai Changhai Hospital; Shanghai China
| | - Xiaofeng Gao
- Department of Urology; Shanghai Changhai Hospital; Shanghai China
| | - Yinghao Sun
- Department of Urology; Shanghai Changhai Hospital; Shanghai China
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