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Mishra A, Mittal J, Tripathi S, Paul S. Factors predicting infective complications following percutaneous nephrolithotomy and retrograde intrarenal surgery according to systemic inflammatory response syndrome and quick sequential organ failure assessment: A prospective study. Urol Ann 2023; 15:295-303. [PMID: 37664105 PMCID: PMC10471817 DOI: 10.4103/ua.ua_150_22] [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: 12/04/2022] [Revised: 12/25/2022] [Accepted: 05/29/2023] [Indexed: 09/05/2023] Open
Abstract
Purpose Myriad operative factors and characteristics of patients may influence the risk of infection in a patient undergoing stone surgery. We prospectively determined the risk factors for systemic inflammatory response syndrome (SIRS) and quick sequential organ failure assessment (qSOFA) in patients undergoing percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). Materials and Methods Patients who underwent PCNL and RIRS from March 2018 to January 2020 satisfying our selection criteria were enrolled. Samples of urine from the renal pelvis, bladder, and retrieved stones were sent for culture testing. Postoperatively patients were keenly supervised for any indications of SIRS and qSOFA. The association between stone and urine cultures across various sites was examined. Regression analysis was performed to ascertain clinical variables affiliated with SIRS and qSOFA. Results The study included a total of 150 patients including both PCNL and RIRS, of which 23% post-PCNL and 20% post-RIRS met the criteria of SIRS and qSOFA. On univariate analysis in PCNL-Dilated pelvicalyceal system (PCS), renal pelvic urine culture (RPUC), stone culture (SC), and operative time >124 min among others were identified as risk factors whereas, in RIRS-residual calculus, RPUC, SC and operative time >62 min were risk factors. Multivariate analysis identified dilated PCS and SC for PCNL and only intraoperative RPUC for RIRS as independent risk factors. Only a significantly strong correlation among culture analysis was found between RPUC and SC in both the procedures. Conclusion Intraoperative RPUC and SCs are better predictors of post-PCNL SIRS while Intraoperative RPUC and duration of surgery are better predictors of post-RIRS sepsis. We, therefore, recommend that both these cultures must routinely be obtained in the above procedures to identify the offending organisms and amend antibiotic therapy during treatment and surgical duration should be kept <62 min in RIRS. SIRS serves as a sensitive review tool which is specifically useful for initial care and on the contrary qSOFA is well suited for patients at greater risk of demise, thereby guiding clinicians to decide future care and course of treatment of patients.
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Affiliation(s)
- Amit Mishra
- Department of Urology, AIIMS, Raebareli, Uttar Pradesh, India
| | - Jayesh Mittal
- Department of Urology, Kota Heart Institute, Kota, Rajasthan, India
| | - Sujata Tripathi
- Department of Pathology, Narayan Medical College and Hospital, Sasaram, Bihar, India
| | - Sourabh Paul
- Department of Community Medicine, AIIMS, Raebareli, Uttar Pradesh, India
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Ye S, Wang W, Yu Z, Luo J. Risk factors for systemic inflammatory response syndrome after endoscopic lithotripsy for upper urinary calculi. BMC Urol 2023; 23:59. [PMID: 37041554 PMCID: PMC10091591 DOI: 10.1186/s12894-023-01230-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 03/29/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND To explore the risk factors for systemic inflammatory response syndrome (SIRS) after endoscopic lithotripsy for upper urinary calculi. METHODS This retrospective study included patients with upper urinary calculi who underwent endoscopic lithotripsy in the First Affiliated Hospital of Zhejiang University between June 2018 and May 2020. RESULTS A total of 724 patients with upper urinary calculi were included. One hundred and fifty-three patients developed SIRS after the operation. The occurrence of SIRS was higher after percutaneous nephrolithotomy (PCNL) compared with ureteroscopy (URS) (24.6% vs. 8.6%, P < 0.001) and after flexible ureteroscopy compared with ureteroscopy (fURS) (17.9% vs. 8.6%, P = 0.042). In the univariable analyses, preoperative infection history (P < 0.001), positive preoperative urine culture (P < 0.001), history of kidney operation on the affected side (P = 0.049), staghorn calculi (P < 0.001), stone long diameter (P = 0.015), stone limited to the kidney (P = 0.006), PCNL (P = 0.001), operative time (P = 0.020), and percutaneous nephroscope channel (P = 0.015) were associated with SIRS. The multivariable analysis showed that positive preoperative urine culture [odds ratio (OR) = 2.23, 95% confidence interval (CI): 1.18-4.24, P = 0.014] and operative methods (PCNL vs. URS, OR = 2.59, 95% CI: 1.15-5.82, P = 0.012) were independently associated with SIRS. CONCLUSION Positive preoperative urine culture and PCNL are independent risk factors for SIRS after endoscopic lithotripsy for upper urinary calculi.
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Affiliation(s)
- Siming Ye
- Urology Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Wei Wang
- Nursing Department, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310006, China.
| | - Zhenliang Yu
- Department of Emergency, Shaoxing People's Hospital, Zhejiang University Shaoxing Hospital), Shaoxing, 312000, China
| | - Jie Luo
- Urology Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310006, China
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Xu BS, Leng FG, Jiang YY, Liao CZ, Wang F, Hu JM, Gao HB, Leng X, Xi HB. A robust localization approach for Percutaneous Nephrolithotomy (PCNL): A single-center retrospective study. Urologia 2023:3915603221148533. [PMID: 36635787 DOI: 10.1177/03915603221148533] [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: 01/14/2023]
Abstract
BACKGROUND Percutaneous Nephrolithotomy (PCNL) represents the gold standard treatment method for cases with large kidney stones. As a critical step in performing PCNL, the procedure of establishing a safe and accurate nephrostomy tract will dramatically impact the treatment quality of patients with large-sized kidney stones. OBJECTIVE This work attempts to describe a new and improved process of establishing an accurate nephrostomy tract and clinically evaluate the effectiveness and safeness of this proposed methodology. METHODS This work represents a retrospective single-center study carried out between August 2013 and November 2019. The collected samples consist of 937 patients who were operated on using PCNL coupled with our proposed procedure. Briefly, a preoperative B-ultrasonography was firstly performed to decide the puncture point in a simulated surgical position where was marked with ureteral catheter segments (2-3 cm). A computed tomography (CT) scan was followed to correct the anchor points in the simulated surgical position. After this, an accurate puncture operation was performed under the real-time guidance of intraoperative B ultrasound. RESULTS Examining this study, 851 subjects with renal stones and 86 subjects with ureteropelvic junction stones were included for the PCNL operation project. All samples were grouped with Guy's grading system: grade I, II, III, and IV patients there were 0.00%, 42.69%, 51.01%, and 6.30%, respectively. Among these patients, the average age was 48.49 ± 10.80 years old, with a male to female ratio of around 1.73:1. CONCLUSIONS This study showed that our developed method warrants an accurate and safe PCNL operation that involves the process of establishing the nephrostomy tract. Other advantageous attributes of this new PCNL process include negligible radiation exposure, lesser complications, and low failure rates. More importantly, this new localization approach is particularly attractive for hospitals that are new to the field of adopting PCNL considering its safeness, effectiveness, and learnability.
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Affiliation(s)
- Bai-Sheng Xu
- The First People's Hospital of Xiushui County, Jiujiang, Jiangxi, China
| | - Fen-Gui Leng
- The First People's Hospital of Xiushui County, Jiujiang, Jiangxi, China
| | - Yan-Ying Jiang
- The First People's Hospital of Xiushui County, Jiujiang, Jiangxi, China
| | - Cai-Zhi Liao
- Creative Biosciences (Guangzhou) Co., Ltd., Guangzhou, China.,The University of Queensland, Brisbane, QLD, Australia
| | - Feng Wang
- The First People's Hospital of Xiushui County, Jiujiang, Jiangxi, China
| | - Jian-Miao Hu
- The First People's Hospital of Xiushui County, Jiujiang, Jiangxi, China
| | - Hong-Bing Gao
- The First People's Hospital of Xiushui County, Jiujiang, Jiangxi, China
| | - Xu Leng
- The First People's Hospital of Xiushui County, Jiujiang, Jiangxi, China
| | - Hai-Bo Xi
- The First Affiliated Hospital of Nanchang University, NanChang, Jiangxi, China
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Zhou G, Zhou Y, Chen R, Wang D, Zhou S, Zhong J, Zhao Y, Wan C, Yang B, Xu J, Geng E, Li G, Huang Y, Liu H, Liu J. The influencing factors of infectious complications after percutaneous nephrolithotomy: a systematic review and meta-analysis. Urolithiasis 2022; 51:17. [PMID: 36515726 PMCID: PMC9750925 DOI: 10.1007/s00240-022-01376-5] [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: 08/05/2022] [Accepted: 11/02/2022] [Indexed: 12/15/2022]
Abstract
Infection is the most common complications of percutaneous nephrolithotomy (PCNL) in treating urinary calculi. However, the risk factors for developing infectious complications after surgery have not been clarified, and the predictive value of some factors is controversial. This study aimed to assess the risk factors for postoperative infectious complications of PCNL. We performed a systematic search of PubMed, Web of Science, Cochrane Library, and EMBASE to obtain studies reporting risk factors for postoperative infection complications after PCNL. In this review, demographic factors, laboratory test factors, and perioperative factors were evaluated. The odds ratio (OR) or mean difference (MD) with a 95% confidence interval (CI) was calculated to assess the risk factors. A total of 18 studies were included, with a total of 7161 study patients with a mean age of 46.4 to 55.5 years and an incidence of infectious complications after PCNL ranging from 2.4% to 40.4%. Twelve factors were identified as independent risk factors for post-PCNL infection complications (P < 0.05), female (OR = 1.60, 95% CI 1.23-2.07), positive urine culture (UC) (OR = 3.16, 95% CI 2.11-4.74), positive renal pelvis urine culture (RPUC) (OR = 5.81, 95% CI 1.75-19.32), positive stone culture (SC) (OR = 5.11, 95% CI 1.46-17.89), positive urine leukocyte (OR = 3.61, 95% CI 2.45-5.34), infected stones (OR = 7.00, 95% CI 1.27-38.55), elevated blood leukocyte (MD = 0.71, 95% CI 0.31-1.10), elevated neutrophil-to-lymphocyte ratio (NLR) (MD = 0.55, 95% CI 0.43-0.66), preoperative stenting (OR = 1.55, 95% CI 1.10-2.20), multiple puncture access (OR = 2.58, 95% CI 1.75-3.82), prolonged operative time (MD = 10 20, 95% CI 4.80-15.60), and postoperative residual stone (OR = 1.56, 95% CI 1.24-1.98). Female, UC positivity, RPUC positivity, SC positivity, urine leukocyte positivity, infected stones, elevated peripheral blood leukocytes, elevated NLR, preoperative stent implantation, multiple puncture channels, prolonged operation time, and postoperative residual stones were identified as independent risk factors for infection complications after PCNL.
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Affiliation(s)
- Guiming Zhou
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, NO. 374 Dianmian Avenue, Wuhua District, Kunming, China
| | - Yuan Zhou
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, NO. 374 Dianmian Avenue, Wuhua District, Kunming, China
| | - Rui Chen
- Xishuangbanna Dai Autonomous Prefecture People's Hospital, Jinghong, Xishuangbanna, Yunnan, China
| | - Daoqi Wang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, NO. 374 Dianmian Avenue, Wuhua District, Kunming, China
| | - Shumin Zhou
- Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Jiao Zhong
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, NO. 374 Dianmian Avenue, Wuhua District, Kunming, China
| | - Yuan Zhao
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, NO. 374 Dianmian Avenue, Wuhua District, Kunming, China
| | - Chuanping Wan
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, NO. 374 Dianmian Avenue, Wuhua District, Kunming, China
| | - Bin Yang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, NO. 374 Dianmian Avenue, Wuhua District, Kunming, China
| | - Jinming Xu
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, NO. 374 Dianmian Avenue, Wuhua District, Kunming, China
| | - Erkang Geng
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, NO. 374 Dianmian Avenue, Wuhua District, Kunming, China
| | - Guoxiong Li
- Menghai County People's Hospital, Menghai, Xishuangbanna, Yunnan, China
| | - Yunfeng Huang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, NO. 374 Dianmian Avenue, Wuhua District, Kunming, China
| | - Haoran Liu
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
| | - Jianhe Liu
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, NO. 374 Dianmian Avenue, Wuhua District, Kunming, China.
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Wang Q, Jiang K, Chen X, Zeng G, Sun F. The Predictive Value of Preoperative Albumin–Globulin Ratio for Systemic Inflammatory Response Syndrome After Percutaneous Nephrolithotomy. Int J Gen Med 2022; 15:7407-7415. [PMID: 36172085 PMCID: PMC9512289 DOI: 10.2147/ijgm.s379741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/13/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Methods Results Conclusion
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Affiliation(s)
- Qing Wang
- Guangzhou Medical University, Guangzhou, People’s Republic of China
- Department of Urology, Guizhou Provincial People’s Hospital, Guiyang, People’s Republic of China
| | - Kehua Jiang
- Department of Urology, Guizhou Provincial People’s Hospital, Guiyang, People’s Republic of China
| | - Xiaolong Chen
- Department of Urology, Guizhou Provincial People’s Hospital, Guiyang, People’s Republic of China
| | - Guohua Zeng
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China
- Correspondence: Guohua Zeng; Fa Sun, Tel +86 020-83062114; Tel +86 0851-85924943, Email ;
| | - Fa Sun
- Department of Urology, Guizhou Provincial People’s Hospital, Guiyang, People’s Republic of China
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Kriplani A, Pandit S, Chawla A, de la Rosette JJMCH, Laguna P, Jayadeva Reddy S, Somani BK. Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) in predicting systemic inflammatory response syndrome (SIRS) and sepsis after percutaneous nephrolithotomy (PNL). Urolithiasis 2022; 50:341-348. [PMID: 35246692 PMCID: PMC9110452 DOI: 10.1007/s00240-022-01319-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/15/2022] [Indexed: 11/16/2022]
Abstract
The objective of this prospective observational study was to assess the clinical significance of neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR) and lymphocyte–monocyte ratio (LMR) as potential biomarkers to identify post-PNL SIRS or sepsis. Demographic data and laboratory data including hemoglobin (Hb), total leucocyte count (TLC), serum creatinine, urine microscopy and culture were collected. The NLR, LMR and PLR were calculated by the mathematical division of their absolute values derived from routine complete blood counts from peripheral blood samples. Stone factors were assessed by non-contrast computerized tomography of kidneys, ureter and bladder (NCCT KUB) and included stone burden (Volume = L × W × D × π × 0.167), location and Hounsfield value and laterality. Intraoperative factors assessed were puncture site, tract size, tract number, operative time, the need for blood transfusion and stone clearance. Of 517 patients evaluated, 56 (10.8%) developed SIRS and 8 (1.5%) developed sepsis. Patients developing SIRS had significantly higher TLC (10.4 ± 3.5 vs 8.6 ± 2.6, OR 1.19, 95% CI 1.09–1.3, p = 0.000002), higher NLR (3.6 ± 2.4 vs 2.5 ± 1.04, OR 1.3, 95% CI = 1.09–1.5, p = 0.0000001), higher PLR (129.3 ± 53.8 vs 115.4 ± 68.9, OR 1.005, 95% CI 1.001–1.008, p = 0.005) and lower LMR (2.5 ± 1.7 vs 3.2 ± 1.8, OR 1.18, 95% CI 1.04–1.34, p = 0.006). Staghorn stones (12.8 vs 3.24%, OR 4.361, 95% CI 1.605–11.846, p = 0.008) and long operative times (59.6 ± 14.01 vs 55.2 ± 16.02, OR 1.01, 95% CI 1.00–1.03, p = 0.05) had significant association with postoperative SIRS. In conclusion, NLR, PLR and LMR can be useful independent, easily accessible and cost-effective predictors for early identification of post-PNL SIRS/sepsis.
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Affiliation(s)
- Akshay Kriplani
- Department of Urology and Renal Transplant, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Shruti Pandit
- Department of Urology and Renal Transplant, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Arun Chawla
- Department of Urology and Renal Transplant, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka India
| | | | - Pilar Laguna
- Istanbul Medipol Mega University Hospital, Istanbul, Turkey
| | - Suraj Jayadeva Reddy
- Department of Urology and Renal Transplant, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Bhaskar K. Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
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Akkas F, Karadag S, Haciislamoglu A. Does the duration between urine culture and percutaneous nephrolithotomy affect the rate of systemic inflammatory response syndrome postoperatively? Urolithiasis 2021; 49:451-456. [PMID: 33864111 DOI: 10.1007/s00240-021-01245-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/15/2021] [Indexed: 11/30/2022]
Abstract
This study aimed to evaluate the preoperative and intraoperative factors that may cause systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL) and to investigate the effect of the duration between urine culture (UC) and operation on postoperative SIRS. Three hundred and fifty-six patients who had PCNL between January 2015 and June 2019 were retrospectively included in the study. UC was obtained from all patients before the operation and during the puncture at the beginning of the operation. Postoperatively, patients were closely monitored for fever and other signs of SIRS. The post-PCNL SIRS incidence was 7%. In univariable and multivariable analyses, the rate of ipsilateral PCNL history, recurrent urinary tract infection (UTI) history, operation time and the length of hospital stay were significant predictive factors for SIRS. The duration between UC and PCNL was not a statistically significant variable in both univariable and multivariable analysis. Our study concluded that the duration between UC and PCNL is not an influential factor for post-PCNL SIRS. Clarifying this issue may be possible with prospective studies in which the effects of factors such as ipsilateral PCNL history and recurrent urinary tract infection history which has been proven to be risk factors for post-PCNL SIRS are restricted.
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Affiliation(s)
- Fatih Akkas
- Department of Urology, Erzurum Regional Training and Research Hospital, University of Health Sciences, Erzurum, 25240, Turkey.
| | - Serdar Karadag
- Department of Urology, Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, 34017, Turkey
| | - Ahmet Haciislamoglu
- Department of Urology, Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, 34017, Turkey
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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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Significance of preoperative systemic immune-inflammation (SII) in predicting postoperative systemic inflammatory response syndrome after percutaneous nephrolithotomy. Urolithiasis 2021; 49:513-519. [PMID: 33835228 DOI: 10.1007/s00240-021-01266-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/27/2021] [Indexed: 12/19/2022]
Abstract
There is evidence that inflammation response biomarkers are positivity associated with bacteremia and urosepsis. The objective of this study was to investigate the value of preoperative systemic immune-inflammation (SII) in predicting systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL). Records from 365 consecutive patients who previously received standard PCNL for kidney stones were retrospectively reviewed. Exactly 108 (29.6%) of the 365 patients who underwent PCNL developed SIRS postoperatively. The association of SIRS with the preoperative risk factors of infectious complications was evaluated. Female gender, operating time, SII, neutrophil to lymphocyte ratio (NLR), and lymphocyte to monocyte ratio (LMR) were found to be independent predictors for post-PCNL SIRS. Female patients with SIRS were more likely to have positive urine culture, a higher level of serum leukocyte, and serum hs-CRP than male patients with SIRS. Receiver operating characteristic curve analysis indicated SII for predicting the occurrence of SIRS with a higher AUC (0.782) than other systemic inflammation biomarkers such as LMR (0.734), NLR (0.671), and PLR (0.617). As a novel integrated inflammation biomarker for predicting SIRS after PCNL, SII showed a better predictive value than other traditional inflammation indicators. To our knowledge, we present the first study to investigate the predictive value of the preoperative SII on post-PCNL SIRS.
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Miniaturized percutaneous Nephrolithotomy without antibiotic prophylaxis: a single institution experience. Int Urol Nephrol 2021; 53:1551-1556. [PMID: 33811627 DOI: 10.1007/s11255-021-02845-3] [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: 01/02/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess the feasibility of sparing routine antibiotic prophylaxis in patients without preoperative urinary tract infection (UTI) undergoing a miniaturized percutaneous nephrolithotomy (mPCNL). PATIENTS AND METHODS A retrospective, monocentric study was conducted to evaluate the outcome of a modified perioperative antibiotic management strategy according to the principles of antibiotic stewardship (ABS). From December 2015 patients undergoing mPCNL for kidney stone with preoperative unremarkable urine culture no longer received an antibiotic prophylaxis (NoPAP). The NoPAP group was compared to mPCNL patients who received standard antibiotic prophylaxis (PAP) in the two years before. Analysis focused on postoperative complications. Logistic regression analysis was performed to identify potential risk factors. RESULTS Postoperative fever occurred in 8% of the NoPAP and 9% of the PAP patients (p = 0.764). Clavien 1-3 complications did not differ between groups with 33% in the NoPAP and 41% in the PAP (p = 0.511). No Clavien 4-5 complications were seen. A (partial) staghorn stone (HR 5.587; p = 0.019) and an infectious stone component (HR 6.313; p = 0.003) were identified as significant risk factors for postoperative fever. By sparing routine antibiotic prophylaxis the overall antibiotic usage was reduced from 100% (PAP) to 9% (NoPAP). CONCLUSION Patients with negative preoperative UC, a none-staghorn stone and no history of recurrent UTI or infectious stones may not need routine antibiotic prophylaxis prior to mPCNL. A prospective validation is warranted.
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Predicting and comparing postoperative infections in different stratification following PCNL based on nomograms. Sci Rep 2020; 10:11337. [PMID: 32647305 PMCID: PMC7347600 DOI: 10.1038/s41598-020-68430-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 06/24/2020] [Indexed: 12/23/2022] Open
Abstract
To discuss the mechanisms of infection complications in different degrees after percutaneous nephrolithotomy (PCNL) through predicting and comparing post-PCNL infections based on nomograms, a retrospective cohort study was conducted among 969 cases who underwent PCNL from Dec 5, 2016 to Dec 25, 2017 in Kunming, Yunnan Province. We examined clinical features, urine routine, blood routine, blood biochemistry, imaging studies and operative information and recorded the examination results before surgery for univariate and multivariate logistic regression. We applied receiver operating characteristic curves, calibration curves, accuracy, specificity, sensitivity, positive predictive value and negative predictive value to evaluate and compare the models. Nomograms were used to visualize the different degrees of postoperative infection complications. The risk scores of the three groups were compared by diabetes mellitus distribution. Our results suggest that the more severe the infection is, the more accurate the model predicts and that the occurrence of severe infection mostly is related to the patients' homeostasis. Hence, we developed an online post-PCNL sepsis dynamic nomogram which can achieve visualization and dynamically predict the incidence of sepsis in postoperative patients.
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Scheidt MJ, Hohenwalter EJ, Pinchot JW, Ahmed O, Bjurlin MA, Braun AR, Kim CY, Knavel Koepsel EM, Schramm K, Sella DM, Weiss CR, Lorenz JM. ACR Appropriateness Criteria® Radiologic Management of Urinary Tract Obstruction. J Am Coll Radiol 2020; 17:S281-S292. [PMID: 32370972 DOI: 10.1016/j.jacr.2020.01.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/25/2020] [Indexed: 11/24/2022]
Abstract
Acute obstructive uropathy is a medical emergency, which often is accompanied by acute renal failure or sepsis. Treatment options to resolve the acute obstructive process include conservative medical management, retrograde ureteral stenting, or placement of percutaneous nephrostomy or nephroureteral catheters. It is important to understand the various treatment options in differing clinical scenarios in order to guide appropriate consultation. Prompt attention to the underlying obstructive process is often imperative to avoid further deterioration of the patient's clinical status. A summary of the data and most up-to-date clinical trials regarding treatment options for urinary tract obstruction is outlined in this publication. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Eric J Hohenwalter
- Panel Chair, Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jason W Pinchot
- Panel Vice-Chair, University of Wisconsin, Madison, Wisconsin
| | | | - Marc A Bjurlin
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; American Urological Association
| | - Aaron R Braun
- St. Elizabeth Regional Medical Center, Lincoln, Nebraska
| | - Charles Y Kim
- Duke University Medical Center, Durham, North Carolina
| | | | - Kristofer Schramm
- University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado
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Small RP, Hendry JL, McKay AC, McPhee AS, Jones GE. Is the qSOFA more reliable than SIRS in detecting post-operative PCNL patients requiring escalation of care? JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415819854889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims Percutaneous nephrolithotomy is known to have a significant risk of sepsis and traditionally the systemic inflammatory response score has been used to identify post-operative patients requiring higher levels of care. Recently, the quick Sepsis Related Organ Failure Assessment score has been developed as a rapid and easy tool to assess patients likely to deteriorate from sepsis. We aim to evaluate the quick Sepsis Related Organ Failure Assessment system against the established systemic inflammatory response score criteria in identifying patients at risk of intensive care unit admission following percutaneous nephrolithotomy. Patients and Methods A retrospective review of 157 patients undergoing percutaneous nephrolithotomy between May 2015 and November 2018 at our institution was performed. Patient demographics of age, sex and American Society of Anesthesiologists’ score were collected. Quick Sepsis Related Organ Failure Assessment and systemic inflammatory response scores were calculated at 24 hours and 7 days post-operatively. Primary outcome was admission to an intensive care unit. Specificity, sensitivity, positive and negative predictive values were calculated for the systemic inflammatory response and quick Sepsis Related Organ Failure Assessment scores. Results Of 157 patients undergoing percutaneous nephrolithotomy, eight (5.1%) and 52 (33.1%) scored positively for quick Sepsis Related Organ Failure Assessment and systemic inflammatory response score criteria within 24 hours. Quick Sepsis Related Organ Failure Assessment scoring had a higher specificity (98.7%: 95% confidence interval 98.6–98.7%) and positive predictive value (75.0: 95% confidence interval 74.0–75.0%) than systemic inflammatory response score criteria (69.5%: 95% confidence interval 69.3–69.7%), (11.5%; 95% confidence interval 1.2–11.8%) in predicting intensive care unit admission following percutaneous nephrolithotomy. Quick Sepsis Related Organ Failure Assessment correlated strongly with intensive care unit admission and overall length of stay, whereas systemic inflammatory response score correlated weakly with both parameters. Conclusion Quick Sepsis Related Organ Failure Assessment demonstrated a statistically significant improvement in predicting intensive care unit admission and overall length of stay versus systemic inflammatory response score criteria following percutaneous nephrolithotomy. Further multi-centre studies are required to validate these findings, which are the first to be published in a urology-specific patient population. Level of Evidence: 4
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Loftus CJ, Hinck B, Makovey I, Sivalingam S, Monga M. Mini Versus Standard Percutaneous Nephrolithotomy: The Impact of Sheath Size on Intrarenal Pelvic Pressure and Infectious Complications in a Porcine Model. J Endourol 2019; 32:350-353. [PMID: 29385812 DOI: 10.1089/end.2017.0602] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To determine how sheath and endoscope size affect intrarenal pelvic pressures and risk of postoperative infectious complications comparing "Mini" vs "Standard" percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS Uropathogenic Escherichia coli were grown and 109 of them were instilled into the porcine renal pelvis through retrograde access for 1 hour. Percutaneous access utilized a 14/16F 20 cm ureteral access sheath for the Mini arm and a 30F sheath for the Standard arm. Nephroscopy was simulated utilizing either an 8/9.8F semirigid ureteroscope or 26F nephroscope for 1 hour while intrarenal pelvic pressure was continuously monitored. Blood and tissue cultures of kidney, liver, and spleen biopsies were plated and incubated and positive cultures were confirmed with polymerase chain reaction. RESULTS Intrapelvic pressures were higher in the Mini group, 18.76 ± 5.82 mm Hg vs 13.56 ± 5.82 mm Hg (p < 0.0001). Time spent above 30 mm Hg was greater in the Mini arm, 117.0 seconds vs 66.1 seconds (p = 0.0452). All pigs had positive kidney tissue cultures whereas spleen cultures were positive in 100% and 60% of pigs in the Mini and Standard arms, respectively (p = 0.0253); 90% and 30% had positive liver tissue culture in the Mini and Standard arms, respectively (p = 0.0062). Blood cultures were positive in 30% of pigs in the Mini arm compared with none in the Standard arm (p = 0.0603). CONCLUSION Mini-PCNL was associated with higher intrarenal pressures and higher risk of end organ bacterial seeding in the setting of an infected collecting system. This suggests a higher potential for infectious complications in a clinical setting.
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Affiliation(s)
- Christopher J Loftus
- 1 Department of Urology, University of Washington Medical Center , Seattle, Washington
| | - Bryan Hinck
- 2 Glickman Urological and Kidney Institute , Cleveland Clinic Cleveland, Ohio
| | - Iryna Makovey
- 2 Glickman Urological and Kidney Institute , Cleveland Clinic Cleveland, Ohio
| | - Sri Sivalingam
- 2 Glickman Urological and Kidney Institute , Cleveland Clinic Cleveland, Ohio
| | - Manoj Monga
- 2 Glickman Urological and Kidney Institute , Cleveland Clinic Cleveland, Ohio
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Shi X, Peng Y, Li X, Wang Q, Li L, Liu M, Gao X, Sun Y. Propensity Score-Matched Analysis Comparing Retrograde Intrarenal Surgery with Percutaneous Nephrolithotomy for Large Stones in Patients with a Solitary Kidney. J Endourol 2019; 32:198-204. [PMID: 29212373 DOI: 10.1089/end.2017.0482] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate the clinical efficacy, safety, and cost of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) in the treatment for large renal stones in patients with a solitary kidney. PATIENTS AND METHODS In this study, 117 patients with a solitary kidney who had undergone PCNL or RIRS for renal stones larger than 2 cm between January 2010 and December 2016 were retrospectively evaluated. The patients' demographic data, clinical characteristics, and perioperative outcomes were collected through a review of their medical records. Forty-three patients treated with PCNL were compared to 43 patients treated with RIRS by propensity score-matched analysis. The stone-free rate, retreatment rate, complication rate, and efficacy quotient (EQ) were assessed in both groups. RESULTS Initial stone-free rate of the PCNL group after a single procedure was significantly higher compared with the RIRS group (74.42% vs 34.88%, p < 0.001), whereas there was no significant difference in the final stone-free rate after repeated procedures (90.70% vs 88.37%, p = 0.713). PCNL had a significantly lower retreatment rate than RIRS (16.28% vs 63.79%, p < 0.001), and the PCNL group underwent fewer procedures than the RIRS group (p < 0.001). Thus, PCNL group had a higher EQ (78.00% vs 53.52%). Although cost per procedure of PCNL was significantly higher compared with RIRS (p < 0.001), the total costs were comparable. Complication rate of RIRS was lower compared with PCNL with no statistical significance (p = 0.193), and acute kidney injury rates were also comparable (PCNL vs RIRS: 13.95% vs 6.98%, p = 0.533). CONCLUSIONS With fewer repeated surgical procedures, higher EQ, and comparable total costs, PCNL is recommended as the first choice for the treatment of large renal calculi in patients with a solitary kidney. As for specific indications such as anticoagulant drugs, RIRS is a safer choice with fewer complications and acceptable final stone-free rate.
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Affiliation(s)
- Xiaolei Shi
- 1 Department of Urology, Shanghai Changhai Hospital, Second Military Medical University , Shanghai, China
| | - Yonghan Peng
- 1 Department of Urology, Shanghai Changhai Hospital, Second Military Medical University , Shanghai, China
| | - Xiao Li
- 2 Department of Radiology, Shanghai Changhai Hospital, Second Military Medical University , Shanghai, China
| | - Qi Wang
- 1 Department of Urology, Shanghai Changhai Hospital, Second Military Medical University , Shanghai, China
| | - Ling Li
- 1 Department of Urology, Shanghai Changhai Hospital, Second Military Medical University , Shanghai, China
| | - Min Liu
- 1 Department of Urology, Shanghai Changhai Hospital, Second Military Medical University , Shanghai, China
| | - Xiaofeng Gao
- 1 Department of Urology, Shanghai Changhai Hospital, Second Military Medical University , Shanghai, China
| | - Yinghao Sun
- 1 Department of Urology, Shanghai Changhai Hospital, Second Military Medical University , Shanghai, China
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Abstract
PURPOSE OF REVIEW To give an overview about state-of-the-art antibiotic prophylaxis in urolithasis therapy and focus on recent publications in this field. RECENT FINDINGS The number of high-quality publications within the recent time is limited. Preoperative inflammatory blood parameters like C-reactive protein and erythrocyte-sedimentation rate might help in prediction of postoperative systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL). White blood cell count is nonpredictive for urinary tract infection (UTI) in patients with acute renal colic. In patients with low risk for infectious complications, antibiotic prophylaxis during shock-wave lithotripsy (SWL) is unnecessary and single-dose antibiotics are comparably effective as prolonged antibiotic usage during PCNL and ureterorenoscopy (URS). SUMMARY Current findings support the American Urological Association (AUA) and European Association of Urology (EAU) guideline recommendations for a risk-adapted minimal antibiotic usage. Single-dose antibiotic prophylaxis is sufficient for low-risk PCNL and URS. For SWL no antibiotic prophylaxis is needed.
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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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Fan BY, Gu L, Chand H, Liu WJ, Yuan JB. Mini-percutaneous nephrolithotomy for pediatric complex renal calculus disease: one-stage or two-stage? Int Urol Nephrol 2018; 51:201-206. [PMID: 30542945 DOI: 10.1007/s11255-018-2054-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/07/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare two different treatment strategies, one-stage and two-stage multi-tract mini-percutaneous nephrolithotomy (mt-mPCNL), for pediatric complex renal calculus disease. METHODS Between the period of July 2016 and July 2018, a total of 36 children aged 15 years and younger, with complex renal calculi disease, who underwent total ultrasound-guided mt-mPCNL by a single experienced urologist were enrolled in our study. All patients were assigned either to Group 1 (n = 18) who received one-stage mt-mPCNL or Group 2 (n = 18) who received planned two-stage mt-mPCNL. RESULTS The demographic data were comparable between the two groups. There were no serious complications (Modified Clavien Grade ≥ III) observed in either group. The stone -free rate (SFR), operation time, postoperative creatinine increase, and perioperative complication rates were similar in both groups (P = 0.603, 0.818, 0.161, and 0.402, respectively). The postoperative hospital stay (5.8 days vs. 7.4 days) and cost (17373.3 CNY vs. 23717.1 CNY) were statistically less in Group 1. Group 2 had significantly less total estimated blood loss (70.6 ml vs. 130.0 ml, P < 0.001). The operation time of two cases in Group 1 with perioperative sepsis or systemic inflammatory response syndrome (SIRS) was more than two hours. CONCLUSIONS Our preliminary results indicated that both one-stage and two-stage mt-mPCNL were safe and effective for pediatric complex renal calculi. Two-stage mt-mPCNL could significantly reduce blood loss; while one-stage mt-mPCNL could significantly decrease the length and costs of hospitalization. We also suggest that the planned two-stage mt-mPCNL should be applied in children with estimated operation time more than two hours.
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Affiliation(s)
- Ben-Yi Fan
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Lan Gu
- Department of Blood Transfusion, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Harripersaud Chand
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Wen-Jun Liu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Jun-Bin Yuan
- Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
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Kaygısız O, Satar N, Güneş A, Doğan HS, Erözenci A, Özden E, Pişkin MM, Demirci D, Toksöz S, Çiçek T, Gürocak S, Kılıçarslan H, Nazlı O, Kefi A, İzol V, Beytur A, Sarıkaya Ş, Tekgül S, Önal B. Factors predicting postoperative febrile urinary tract infection following percutaneous nephrolithotomy in prepubertal children. J Pediatr Urol 2018; 14:448.e1-448.e7. [PMID: 29779995 DOI: 10.1016/j.jpurol.2018.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/08/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Predictive tables and scoring systems can predict stone clearance. However, there is a paucity of evidence regarding the prediction of complications during percutaneous nephrolithotomy (PCNL), particularly in children, which remains under-researched. To our knowledge, no studies have evaluated the risk factors for febrile urinary tract infection (FUTI) after pediatric PCNL. OBJECTIVES To assess the predictive factors of FUTI in prepubertal children after PCNL and determine whether any prophylactic cephalosporins are superior for decreasing the FUTI rate. STUDY DESIGN Data from 1157 children who underwent PCNL between 1991 and 2012 were retrieved from the multicenter database of the Turkish Pediatric Urology Society. Children >12 years of age were excluded, leaving 830 children (364 girls, 466 boys). Data were analyzed according to the presence of FUTI and compared between the FUTI and non-FUTI groups. RESULTS Mean age was 6.46 ± 3.38 years. Twenty-nine (3.5%) children had FUTI which was confirmed by urine culture. FUTI occurred more frequently in young children (5.5%) than school-age children (2.4%). In univariate analysis, there were significant differences between the FUTI and non-FUTI groups regarding age, cephalosporin subgroup (first, second and third generation cephalosporin), side of PCNL, staghorn stones, tract size, operative time, postoperative ureteral catheter usage, perioperative complications (SATAVA), and blood transfusion. Multivariate analysis revealed that age, side of PCNL, staghorn stones, tract size, operative time, and blood transfusion were independent predictors of FUTI. DISCUSSION The smaller tract size could cause FUTI with poor fluid drainage that may lead to elevate renal pelvic pressure and trigger bacteremia-causing pyelovenous backflow. Filling the calyx and renal pelvis by a staghorn stone and the resulting obstruction of fluid drainage may elevate intrarenal pelvis pressure. Longer operative time is likely to increase renal pelvic pressure over longer periods, which may account for FUTI after pediatric PCNL. CONCLUSIONS Younger age, right-sided PCNL, staghorn stones, mini-PCNL, longer operative time, and blood transfusion are risk factors for FUTI. First-, second-, and third-generation cephalosporins are equally effective for prophylaxis in prepubertal children undergoing PCNL.
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Affiliation(s)
- Onur Kaygısız
- Department of Urology, Uludağ University Faculty of Medicine, Bursa, Turkey.
| | - Nihat Satar
- Department of Urology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Ali Güneş
- Department of Urology, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Hasan Serkan Doğan
- Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Erözenci
- Department of Urology, Istanbul University, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Ender Özden
- Department of Urology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Mehmet Mesut Pişkin
- Department of Urology, Necmetin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
| | - Deniz Demirci
- Department of Urology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Serdar Toksöz
- Department of Urology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Tufan Çiçek
- Department of Urology, Baskent University Faculty of Medicine, Konya, Turkey
| | - Serhat Gürocak
- Department of Urology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Hakan Kılıçarslan
- Department of Urology, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Oktay Nazlı
- Department of Urology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Aykut Kefi
- Department of Urology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Volkan İzol
- Department of Urology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Ali Beytur
- Department of Urology, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Şaban Sarıkaya
- Department of Urology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Serdar Tekgül
- Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Bülent Önal
- Department of Urology, Istanbul University, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
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Risk factors for systemic inflammatory response syndrome after percutaneous nephrolithotomy. Prog Urol 2018; 28:582-587. [PMID: 30301521 DOI: 10.1016/j.purol.2018.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/03/2018] [Accepted: 06/07/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To explore the risk factors for systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL). METHODS A retrospective chart review was performed to identify 1030 patients who had undergone PCNL from January 2014 to July 2016 in the Minimally Invasive Surgery Center. Multiple data, including age, sex, body mass index (BMI), operation time, Staghorn calculi, diabetes, Serun creatinine, preoperative urine culture and the urinary sediment microscopy white blood cell (WBC) were collected. These factors and postoperative SIRS were retrospectively analyzed. RESULTS There were 108 cases (10.49%) of SIRS among 1030 patients. The results of univariate analysis showed that sex (P=0.015), Staghorn calculi (P<0.001), preoperative urinary culture of Gram-negative bacteria (P<0.001) and preoperative urinary sediment microscopy WBC (+, ++, +++, ++++) (P<0.001, P<0.001, P=0.009, P=0.045) were correlated with postoperative SIRS (P<0.05). According to Multivariate analysis results, the likelihood of SIRS after PCNL increased with Staghorn calculi (P=0.01, OR=10.457, 95% CI=1.312-3.092), the urinary sediment microscopy WBC (+∼++++) (P<0.001, OR=2.591, 95% CI=1.661-4.042) and positive urine culture for Gram-negative bacteria (P<0.001, OR=3.550, 95% CI=2.205-5.715). CONCLUSIONS Staghorn calculi, the urinary sediment microscopy WBC and positive urine culture for Gram-negative bacteria are independent risk factors for SIRS. Patients affected by these risk factors should receive careful anti-infectious perioperative management for prevention of postoperative SIRS. LEVEL OF INCIDENCE 4.
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Fever and systemic inflammatory response syndrome after retrograde intrarenal surgery: Risk factors and predictive model. Kaohsiung J Med Sci 2018; 34:400-408. [DOI: 10.1016/j.kjms.2018.01.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 11/17/2017] [Accepted: 01/03/2018] [Indexed: 12/23/2022] Open
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Degirmenci T, Bozkurt IH, Celik S, Yarimoglu S, Basmaci I, Sefik E. Does leaving residual fragments after percutaneous nephrolithotomy in patients with positive stone culture and/or renal pelvic urine culture increase the risk of infectious complications? Urolithiasis 2018; 47:371-375. [PMID: 29869167 DOI: 10.1007/s00240-018-1063-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 06/01/2018] [Indexed: 11/30/2022]
Abstract
The residual fragments in patients with preoperative and intraoperative culture positivity may serve as an infection focus. The aim of this study was to assess the importance of residual fragments for developing SIRS in patients with stone culture and/or RPUC positivity. After obtaining institutional review board approval, a total of 729 patients who undergone PCNL for renal stones were included in this study. Residual fragments accepted to be positive if any fragment was detected irrespective of size. All patients were followed-up postoperatively for SIRS criteria. The patients were then followed-up for residual stone-related events and infectious complications. 94 of the 729 patients have developed SIRS postoperatively. SIRS positivity was more common among males and found to be associated with higher stone burden and presence of staghorn stone. Patients with residual fragments after PCNL also had higher rates of SIRS. In the subgroup analysis of 203 patients who had post-PCNL residual fragments, the peroperative stone and/or RPUC positivity was not found to be associated with the development of the SIRS. Although presence of residual fragments after PCNL is associated with SIRS development, stone culture and/or RPUC positivity has no additional risk for development of post-PCNL infectious complications in patients with residual fragments.
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Affiliation(s)
- Tansu Degirmenci
- Department of Urology, HSU Izmir Bozyaka Training and Research Hospital, Saim Cikrikci Str. No: 59 Bozyaka, Izmir, Turkey
| | - Ibrahim Halil Bozkurt
- Department of Urology, HSU Izmir Bozyaka Training and Research Hospital, Saim Cikrikci Str. No: 59 Bozyaka, Izmir, Turkey.
| | - Serdar Celik
- Department of Urology, HSU Izmir Bozyaka Training and Research Hospital, Saim Cikrikci Str. No: 59 Bozyaka, Izmir, Turkey
| | - Serkan Yarimoglu
- Department of Urology, HSU Izmir Bozyaka Training and Research Hospital, Saim Cikrikci Str. No: 59 Bozyaka, Izmir, Turkey
| | - Ismail Basmaci
- Department of Urology, HSU Izmir Bozyaka Training and Research Hospital, Saim Cikrikci Str. No: 59 Bozyaka, Izmir, Turkey
| | - Ertugrul Sefik
- Department of Urology, HSU Izmir Bozyaka Training and Research Hospital, Saim Cikrikci Str. No: 59 Bozyaka, Izmir, Turkey
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Tan F, Gan X, Deng Y, Li X, Guo N, Hei Z, Zhu Q, Chen ZG, Zhou S. Intraoperative dexmedetomidine attenuates postoperative systemic inflammatory response syndrome in patients who underwent percutaneous nephrolithotomy: a retrospective cohort study. Ther Clin Risk Manag 2018; 14:287-293. [PMID: 29497305 PMCID: PMC5818878 DOI: 10.2147/tcrm.s157320] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Purpose Dexmedetomidine (DEX) has been reported to attenuate inflammation in rats. The present retrospective cohort study aimed to investigate whether intraoperative administration with DEX could reduce the incidence of postoperative systemic inflammatory response syndrome (SIRS) in patients following percutaneous nephrolithotomy (PCNL). Patients and methods A total of 251 patients were included in the analysis. Among these patients, 175 received intravenous DEX infusion during the intraoperative period and 76 did not. The primary outcome measures were the incidences of postoperative SIRS and fever. Secondary outcomes included patient-controlled analgesia (tramadol) requirements, length of postoperative hospitalization stay, serum creatinine (Scr) and serum blood urea nitrogen (BUN) concentration, and adverse events (bradycardia, hypotension, renal artery thrombosis). Results Administration of DEX not only significantly attenuated the incidence of SIRS and fever (P=0.029, P=0.042, respectively), but also reduced analgesia requirements (P=0.028). The length of postoperative hospitalization stay, Scr and BUN concentration, and adverse events did not differ significantly between the two groups. Further univariate and multivariate logistic regression analysis indicated that intraoperative DEX administration was a protective factor against SIRS after PCNL (OR 0.476 [95% CI: 0.257-0.835]; P=0.019). Conclusion Intraoperative administration of DEX might be associated with reductions in the incidences of SIRS and fever after PCNL.
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Affiliation(s)
- Fang Tan
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.,Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Xiaoliang Gan
- Department of Anesthesiology, Zhongshan Ophthalmic Center of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yingqing Deng
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiaoyun Li
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Na Guo
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ziqing Hei
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Qianqian Zhu
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zhuang-Gui Chen
- Department of Pediatric Intensive Care Unit, Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Shaoli Zhou
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
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Ganesan V, Brown RD, Jiménez JA, De S, Monga M. C-Reactive Protein and Erythrocyte Sedimentation Rate Predict Systemic Inflammatory Response Syndrome After Percutaneous Nephrolithotomy. J Endourol 2017; 31:638-644. [DOI: 10.1089/end.2016.0884] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Vishnu Ganesan
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
- Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Robert D. Brown
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Shubha De
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Manoj Monga
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
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The Evaluation of Risk Factors for Postoperative Infectious Complications after Percutaneous Nephrolithotomy. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4832051. [PMID: 28261611 PMCID: PMC5312048 DOI: 10.1155/2017/4832051] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 01/05/2017] [Accepted: 01/11/2017] [Indexed: 11/17/2022]
Abstract
This study was to evaluate the risk factors of infectious complications after percutaneous nephrolithotomy (PCNL) and build a prediction tool for postoperative complications based on the risk factors. A total of 110 male (67.1%) and 54 female (32.9%) patients who underwent PCNL for renal stones between 2010 and 2014 in our institute were included. A detailed clinical information and laboratory results were obtained from patients. Systemic inflammatory response syndrome (SIRS) and postoperative fever were recorded after PCNL surgery. In all, 45 cases (27.4%) developed SIRS and fever was observed in 20 cases (12.2%). In multivariate analysis, stone size (odds ratio, OR = 1.471, p = 0.009) and urine white blood cell (WBC) (OR = 1.001, p = 0.007) were related to the development of SIRS. Stone size (OR = 1.644, p = 0.024), urine WBC (OR = 1.001, p = 0.002) and serum albumin (OR = 0.807, p = 0.021) were associated with postoperative fever. We concluded that patients with larger stone size and preoperative urinary tract infection might have a higher risk of developing SIRS and fever after operation, while a high-normal level of serum albumin might be the protective factor for postoperative fever.
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Bansal SS, Pawar PW, Sawant AS, Tamhankar AS, Patil SR, Kasat GV. Predictive factors for fever and sepsis following percutaneous nephrolithotomy: A review of 580 patients. Urol Ann 2017; 9:230-233. [PMID: 28794587 PMCID: PMC5532888 DOI: 10.4103/ua.ua_166_16] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
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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Affiliation(s)
- Sumit Suresh Bansal
- Department of Urology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Prakash Wamanrao Pawar
- Department of Urology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Ajit S Sawant
- Department of Urology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Ashwin Sunil Tamhankar
- Department of Urology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Sunil Raghunath Patil
- Department of Urology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Gaurav Vinod Kasat
- Department of Urology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
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Postpercutaneous Nephrolithotomy Systemic Inflammatory Response Syndrome Is Not Associated With Unplanned Readmission. Urology 2016; 100:33-37. [PMID: 27641935 DOI: 10.1016/j.urology.2016.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/07/2016] [Accepted: 09/03/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the incidence of systemic inflammatory response syndrome (SIRS) following percutaneous nephrolithotomy (PCNL) and evaluate any association with unplanned 90-day readmission. METHODS We retrospectively reviewed consecutive patients undergoing PCNL in 2 dedicated endourologic practices between 2009 and 2013. We collected patient demographics, perioperative culture data, and operative characteristics. SIRS was defined as having 2 or more of the following: maximum white blood cell count >12,000 or <4000, temperature >38 or <34°C, heart rate >90, and respiratory rate >20 within the first 24 hours following PCNL. Proportions between groups were compared to identify significant associations. RESULTS We identified 389 patients undergoing PCNL and 43% (167 of 389) met SIRS criteria, more commonly in patients with multiple PCNL accesses (OR 2.3; CI: 1.1-4.8, P = .025). Readmission was required in 8% (31 of 389), most commonly for infection (n = 21). Although possession of a struvite stone was associated with unplanned readmission (16% vs 4%, P < .01), SIRS in the absence of fever within 48 hours postoperative was not associated with readmission (29.4% vs 25.8%, P = .837). CONCLUSION Nearly half of the patients undergoing PCNL met the criteria for SIRS within the first postoperative day. There was no association between SIRS and unplanned readmission in the postoperative PCNL patient. Despite discharge during the first postoperative day, patients with SIRS (without fever or struvite stones) had no increased risk for unplanned return. Our findings suggest that the development of SIRS immediately following PCNL does not preclude safe discharge on the first postoperative day.
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Significance of preoperative neutrophil-lymphocyte count ratio on predicting postoperative sepsis after percutaneous nephrolithotomy. Kaohsiung J Med Sci 2016; 32:507-513. [PMID: 27742034 DOI: 10.1016/j.kjms.2016.08.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 08/10/2016] [Accepted: 08/12/2016] [Indexed: 12/12/2022] Open
Abstract
We evaluated the usefulness of preoperative neutrophil-lymphocyte count ratio (NLCR) in predicting postoperative sepsis after percutaneous nephrolithotomy (PCNL). In total, 487 patients who underwent PCNL for renal stones were included in the present retrospective study. The stone burden, number of tracts and location, operation time, fluoroscopy time, presence of residual stones, and blood transfusion rates were postoperatively recorded in all patients. All patients were followed up for signs of systemic inflammatory response syndrome (SIRS) and sepsis. The association of sepsis/SIRS with the risk factors of infectious complications, including NLCR, was evaluated. SIRS was detected in 91 (18.7%) patients, 25 (5.1%) of whom were diagnosed with sepsis. Stone burden, operation time, irrigation rate, previous surgery, nephrostomy time, access number, blood transfusion, residual stone, postoperative urinary culture, renal pelvis urinary culture, and stone culture were found to be predictive factors for SIRS and sepsis development. Receiver operating characteristic curve analysis revealed an NLCR cutoff of 2.50 for predicting the occurrence of SIRS/sepsis. We found that the incidence of sepsis was significantly higher in patients with NLCR ≥ 2.50 than in patients with NLCR < 2.50 (p = 0.006). Preoperative and postoperative urine culture positivity were associated with high NLCR (p = 0.039 and p = 0.003, respectively). We believe that preoperative NLCR may be a promising additive predictor of bacteremia and postoperative sepsis in patients who undergo PCNL for renal stones. This marker is simple, easily measured, and easy to use in daily practice without extra costs.
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Rivera M, Viers B, Cockerill P, Agarwal D, Mehta R, Krambeck A. Pre- and Postoperative Predictors of Infection-Related Complications in Patients Undergoing Percutaneous Nephrolithotomy. J Endourol 2016; 30:982-6. [PMID: 27393153 DOI: 10.1089/end.2016.0191] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION We aim to describe pre- and postoperative predictors of infection-related complications in individuals undergoing percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS Patients treated with PCNL from 2009 to 2013 were reviewed. Patients with positive urine or stone cultures received extended antimicrobial treatment. All others received 7 days of empirical therapy preoperatively and postoperatively. Pre- and postoperative predictors of infectious complication were identified. RESULTS We identified 227 patients who underwent primary PCNL with infectious complications occurring in 37 (16%): 11 (5%) urinary tract infection/pyelonephritis, 21 (9%) systemic inflammatory response syndrome (SIRS), and 2 (0.9%) sepsis. There were no significant differences between those with and without infectious complication with regard to age, gender, stone size, presence of diabetes, or procedure duration. Those with infectious complication were more likely to have a positive intraoperative stone culture (p = 0.01), struvite stone composition (p < 0.01), staghorn calculi (p < 0.001), and multiple stones (p = 0.02). Preoperatively, on multivariable analysis, only the presence of a staghorn calculus remained independently associated with increased risks of fever/SIRS/sepsis (odds ratio [OR] 3.14; p = 0.02) and total infectious complications (OR 2.53; p = 0.02) following PCNL. After controlling for pre- and post-PCNL risk factors, again, only staghorn calculi remained significantly associated with fever/SIRS/sepsis (OR 3.41; p = 0.01) and total infectious complications (OR 2.91; p = 0.01), with presence of multiple stones approaching significance (OR 4.2, confidence interval [CI]: 0.96, 18.6; p = 0.06). CONCLUSIONS In individuals undergoing PCNL on preoperative antibiotics, risk of SIRS/sepsis was low. The presence of a staghorn calculus confers a greater than threefold increased risk of postoperative infection with multiple stones approaching a significant risk. Patients with large stone burdens should be counseled appropriately regarding these risks.
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Affiliation(s)
| | - Boyd Viers
- 1 Department of Urology, Mayo Clinic , Rochester, Minnesota
| | | | - Deepak Agarwal
- 1 Department of Urology, Mayo Clinic , Rochester, Minnesota
| | - Ramila Mehta
- 1 Department of Urology, Mayo Clinic , Rochester, Minnesota.,2 Division of Biomedical Statistics and Informatics, Mayo Clinic , Rochester, Minnesota
| | - Amy Krambeck
- 1 Department of Urology, Mayo Clinic , Rochester, Minnesota
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Berardinelli F, De Francesco P, Marchioni M, Cera N, Proietti S, Hennessey D, Dalpiaz O, Cracco C, Scoffone C, Schips L, Giusti G, Cindolo L. Infective complications after retrograde intrarenal surgery: a new standardized classification system. Int Urol Nephrol 2016; 48:1757-1762. [DOI: 10.1007/s11255-016-1373-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 07/13/2016] [Indexed: 10/21/2022]
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31
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Omar M, Noble M, Sivalingam S, El Mahdy A, Gamal A, Farag M, Monga M. Systemic Inflammatory Response Syndrome after Percutaneous Nephrolithotomy: A Randomized Single-Blind Clinical Trial Evaluating the Impact of Irrigation Pressure. J Urol 2016; 196:109-14. [PMID: 26869311 DOI: 10.1016/j.juro.2016.01.104] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE We evaluated the impact of intraoperative irrigation pressures on the risk of systemic inflammatory response after percutaneous nephrolithotomy. MATERIALS AND METHODS Between January 2014 and March 2015, 90 patients with renal stones planned for percutaneous nephrolithotomy were randomized between low (80 mm Hg) and high (200 mm Hg) irrigation pressure. Patient demographics, perioperative outcomes and systemic inflammatory response incidence rates were compared using the chi-square and Wilcoxon signed rank tests. RESULTS Mean patient age, gender, body mass index and other perioperative outcomes were similar in both arms. High pressure irrigation was associated with a higher risk of systemic inflammatory response syndrome (46%) compared to low pressure irrigation (11%, p=0.0002). On multivariate analysis only high irrigation pressure, paraplegia or neurogenic bladder and nonquinolone perioperative medication were predictive of postoperative systemic inflammatory response syndrome. CONCLUSIONS High pressure fluid irrigation fluid increases the risk of postoperative systemic inflammatory response syndrome after percutaneous nephrolithotomy.
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Osman Y, Elshal AM, Elawdy MM, Omar H, Gaber A, Elsawy E, El-Nahas AR. Stone culture retrieved during percutaneous nephrolithotomy: is it clinically relevant? Urolithiasis 2016; 44:327-32. [DOI: 10.1007/s00240-016-0858-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 12/30/2015] [Indexed: 11/30/2022]
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Singh P, Yadav S, Singh A, Saini AK, Kumar R, Seth A, Dogra PN. Systemic Inflammatory Response Syndrome Following Percutaneous Nephrolithotomy: Assessment of Risk Factors and Their Impact on Patient Outcomes. Urol Int 2016; 96:207-11. [PMID: 26745881 DOI: 10.1159/000441954] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/06/2015] [Indexed: 11/19/2022]
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.
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Affiliation(s)
- Prabhjot Singh
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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Ramaraju K, Paranjothi AK, Namperumalsamy DB, Chennakrishnan I. Predictors of systemic inflammatory response syndrome following percutaneous nephrolithotomy. Urol Ann 2016; 8:449-453. [PMID: 28057990 PMCID: PMC5100151 DOI: 10.4103/0974-7796.192108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction and Objectives: Sepsis remains one of the dreaded complications of percutaneous nephrolithotomy (PCNL). To analyze prospectively the preoperative and intraoperative factors that predict the occurrence of systemic inflammatory response syndrome (SIRS) in patients undergoing PCNL so that we can aggressively manage those patients from the preoperative period itself and avert the dangerous complications. Materials and Methods: A prospective study was carried out between August 2012 and March 2013 including all patients who underwent PCNL. Patients with infected collecting system, synchronous ureteric stones, stents, or percutaneous nephrostomy drainage were excluded from the study. Patients were evaluated with physical examination, urine analysis, urine culture and sensitivity, complete blood count, renal function test, X-ray kidney, ureter, and bladder (KUB), and plain and contrast-enhanced computerized tomography KUB. Patients who developed any two or above of the following in the postoperative period were considered to have developed SIRS. (1) Temperature >100.4°F (38°C) or <96.8°F (36°C). (2) Pulse rate >90/min. (3) Respiratory rate >20/min. (4) White blood cell count >12,000/ml or <4000/ml. Results: Of the 120 patients who underwent PCNL 29 (24.1%) developed features of SIRS. On univariate analysis, gender, diabetes mellitus, bladder urine culture, and serum creatinine were found to be statistically insignificant. Blood transfusion (P = 0.009), no of access tracts (P = 0.001), pelvic urine culture (P = 0.04), stone culture (P = 0.003), stone size (P = 0.001), age (P = 0.019), and operative time (P = 0.004) were found to be statistically significant. On multivariate regression analysis stone size, no of access tracts, operative time, and stone culture were found to be statistically significant with regard to the occurrence of SIRS. Conclusion: Patients with above-identified risk factors must be aggressively treated to prevent the occurrence of sepsis postoperatively.
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Chew BH, Flannigan R, Kurtz M, Gershman B, Arsovska O, Paterson RF, Eisner BH, Lange D. A Single Dose of Intraoperative Antibiotics Is Sufficient to Prevent Urinary Tract Infection During Ureteroscopy. J Endourol 2016; 30:63-8. [DOI: 10.1089/end.2015.0511] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ben H. Chew
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Ryan Flannigan
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Kurtz
- Department of Urology, Massachusetts General Hospital, Harvard Medical School
| | - Boris Gershman
- Department of Urology, Massachusetts General Hospital, Harvard Medical School
| | - Olga Arsovska
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Ryan F. Paterson
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian H. Eisner
- Department of Urology, Massachusetts General Hospital, Harvard Medical School
| | - Dirk Lange
- University of British Columbia, Vancouver, British Columbia, Canada
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Sharma K, Sankhwar SN, Goel A, Singh V, Sharma P, Garg Y. Factors predicting infectious complications following percutaneous nephrolithotomy. Urol Ann 2016; 8:434-438. [PMID: 28057987 PMCID: PMC5100148 DOI: 10.4103/0974-7796.192105] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: To determine the predictors of infectious complications following percutaneous nephrolithotomy (PCNL) in a prospective study. Materials and Methods: A total of 332 patients with renal or upper ureteric calculi who underwent PCNL between January 2013 and June 2014 were included in the study. Infectious complications included febrile urinary tract infection and septicemia. The patients were divided into Group A and B depending on whether they developed or did not develop infectious complications. Patient, stone, renal, and procedure-related factors were compared between the two groups. Results: There was no significant (P > 0.05) correlation among age (37.03 ± 16.24 vs. 36.72 ± 14.88), sex, and body mass index (21.00 ± 1.77 vs. 21.03 ± 2.25) between Group A and B. The patients in Group A were found to have significantly higher incidence of renal failure (39.5% vs. 9.2%,P= 0.0001), diabetes mellitus (12 [31.5%] vs. 33 [11.2%],P= 0.0001), previous percutaneous nephrostomy (PCN) tube placement (11 [28%] vs. 21 [7.1%]P= 0.0001), moderate to severe hydronephrosis (HDN), larger stone surface area (812.68 ± 402.07 vs. 564.92 ± 361.32,P= 0.0001), mean number of punctures (1.57 ± 0.50 vs. 1.20 ± 0.47,P= 0.002), and mean duration of surgery (94.28 ± 18.23 vs. 69.12 ± 21.23,P= 0.0001) than Group B. Conclusion: Post-PCNL infectious complications were found to be more common in patients with renal failure, diabetes mellitus, preoperative PCN placement, staghorn calculi, severe HDN, multiple punctures, and prolonged duration of surgery.
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Affiliation(s)
- Kuldeep Sharma
- Department of Urology, King George Medical University, Lucknow, Uttar Pradesh, India
| | | | - Apul Goel
- Department of Urology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Vishwajeet Singh
- Department of Urology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Pradeep Sharma
- Department of Urology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Yogesh Garg
- Department of Urology, King George Medical University, Lucknow, Uttar Pradesh, India
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Zhao Z, Cui Z, Zeng T, Wan SP, Zeng G. Comparison of 1-stage With 2-stage Multiple-tracts Mini-percutaneous Nephrolithotomy for the Treatment of Staghorn Stones: A Matched Cohorts Analysis. Urology 2016; 87:46-51. [DOI: 10.1016/j.urology.2015.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/10/2015] [Accepted: 09/05/2015] [Indexed: 10/22/2022]
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Bozkurt IH, Aydogdu O, Yonguc T, Koras O, Sen V, Yarimoglu S, Degirmenci T. Predictive Value of Leukocytosis for Infectious Complications After Percutaneous Nephrolithotomy. Urology 2015; 86:25-9. [PMID: 26142577 DOI: 10.1016/j.urology.2015.04.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 03/19/2015] [Accepted: 04/23/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the natural history of white blood cell (WBC) values and incidence of leukocytosis after percutaneous nephrolithotomy (PCNL), factors associated with development of postoperative leukocytosis, and predictive value of WBC count for infection. METHODS A total of 303 patients who underwent PCNL for renal stones were included in the recent study. Electronic medical records of the patients were reviewed retrospectively to collect daily serum leukocyte counts and perioperative cultures. WBC count was followed daily for patients with positive urine culture and/or postoperative fever until leukocyte levels turned to normal limits. RESULTS Leukocytosis was detected in 133 of the 303 patients (43.9%). The mean preoperative and postoperative WBC counts were 7.73 ± 2.01 × 10(6) cells/μL and 11.9 ± 3.31 × 10(6) cells/μL, respectively. The average postoperative WBC count increased by 4.2 ± 2.99 × 10(6) cells/μL over the first 2 postoperative days. Receiver operating characteristic curve analysis resulted in an area under the curve of 0.87 and 0.80 for postoperative WBC count and absolute WBC count difference, respectively. The thresholds provided by the analysis were 14.05 × 10(6) cells/μL and an increase greater than 5.25 × 10(6) cells/μL, respectively. CONCLUSION Our data show postoperative leukocytosis is common after PCNL and represents a normal physiologic response to surgery. Our study demonstrated that 14.05 × 10(3) × 10(6) cells/μL WBC count and absolute difference in WBC count from baseline of 5.25 × 10(3) × 10(6) cells/μL were significantly associated with post-PCNL sepsis development. Further studies are needed to determine the significance of leukocytosis for infectious complications after PCNL.
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Affiliation(s)
| | - Ozgu Aydogdu
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Tarik Yonguc
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Omer Koras
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Volkan Sen
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Serkan Yarimoglu
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Tansu Degirmenci
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
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Zhong W, Leto G, Wang L, Zeng G. Systemic inflammatory response syndrome after flexible ureteroscopic lithotripsy: a study of risk factors. J Endourol 2015; 29:25-8. [PMID: 24999535 DOI: 10.1089/end.2014.0409] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To evaluate the risk factors for systemic inflammatory response syndrome (SIRS) after flexible ureteroscopic lithotripsy (FUL). MATERIALS AND METHODS Patients who underwent FUL between October 2012 and November 2013 were studied. Complete data was available for 260 adult patients who met this criteria. Preoperative and intraoperative risk factors that potentially contribute to SIRS were compared in patients who developed postoperative SIRS and those who did not. Furthermore, multivariable logistic regression analysis was performed and the odds ratio (OR) and 95% confidence interval (CI) were calculated to identify the independent risk factors for SIRS after FUL. RESULTS The incidence of SIRS after FUL was 8.1%. In the univariate test analysis, significant correlation between SIRS and four factors was noted: sex of the patient (P<0.001), stone size (P=0.001), irrigation flow rate (P<0.001), and irrigation volume (P<0.001). Multivariable logistic regression analysis identified stone size (OR=1.691; 95% CI,0.879-3.255), small-caliber ureteral access sheath (UAS) (OR=2.293; 95% CI, 0.730-7.200), irrigation flow rate (OR=1.161; 95% CI, 1.096-1.230), and struvite calculi (OR=3.331; 95% CI, 0.971-11.426) as independent risk factors for SIRS after FUL. CONCLUSIONS We recommend that the length of lithotripsy be well controlled in patients with large stone burden and struvite calculi. Staging procedures are also required. Additionally, irrigating with a low flow rate and low pressure and using a large-caliber UAS for better drainage are required to keep a low renal pelvic pressure during FUL procedures.
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Affiliation(s)
- Wen Zhong
- 1 Department of Urology, First Affiliated Hospital of Guangzhou Medical University , and Guangdong Key Laboratory of Urology, Guangzhou, China
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Patel N, Shi W, Liss M, Raheem O, Wenzler D, Schallhorn C, Kiyama L, Lakin C, Ritter M, Sur RL. Multidrug Resistant Bacteriuria Before Percutaneous Nephrolithotomy Predicts for Postoperative Infectious Complications. J Endourol 2015; 29:531-6. [DOI: 10.1089/end.2014.0776] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Nishant Patel
- Department of Urology, University of California San Diego Health System, San Diego, California
| | | | - Michael Liss
- Department of Urology, University of California San Diego Health System, San Diego, California
| | - Omer Raheem
- Department of Urology, University of California San Diego Health System, San Diego, California
| | - David Wenzler
- Department of Urology, University of California San Diego Health System, San Diego, California
| | - Craig Schallhorn
- University of California San Diego School of Medicine, San Diego, California
| | - Linsday Kiyama
- University of California San Diego School of Medicine, San Diego, California
| | - Charles Lakin
- Department of Urology, University of California San Diego Health System, San Diego, California
| | - Michele Ritter
- Department of Urology, University of California San Diego Health System, San Diego, California
| | - Roger L. Sur
- Department of Urology, University of California San Diego Health System, San Diego, California
- Veterans Affairs San Diego Medical Center, San Diego, California
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Falahatkar S, Moghaddam KG, Kazemnezhad E, Farzan A, Aval HB, Ghasemi A, Shahab E, Esmaeili SS, Motiee R, Langroodi SAM, Nemati M, Allahkhah A. Factors affecting complications according to the modified Clavien classification in complete supine percutaneous nephrolithotomy. Can Urol Assoc J 2015; 9:e83-92. [PMID: 25737769 DOI: 10.5489/cuaj.2248] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION An increase in percutaneous nephrolithotomy (PCNL) has been accompanied by an increase in complications. We identified the parameters affecting the severity of complications using the modified Clavien classification (MCC). METHODS From 2008 to 2013, 330 patients underwent complete supine PCNL using subcostal access, one-shot dilation, rigid nephroscopy, and pneumatic lithotripsy. We assessed the impact of the following factors on complication severity based on the MCC: age, gender, body mass index, hypertension, diabetes, previous stone surgery and extracorporeal shock wave lithotripsy, preoperative hemoglobin, renal dysfunction (creatinine >1.4 mg/dL), preoperative urinary tract infection, anatomic upper urinary tract abnormality (AUUTA), significant (moderate-severe) hydronephrosis, stone-related parameters (opacity, number, burden, location, staghorn, complex stones), anesthesia type, kidney side, imaging and calyx for access, tract number, tubeless approach, operative time, postoperative hemoglobin, and hemoglobin drop and stone-free results. RESULTS The complication rate was 19.7% (MCC: 0=80.3%, I=6.4%, II=11.2%, ≥III=2.1%). On univariate analyses, only the following factors affected MCC: gender, preoperative hemoglobin, AUUTA, significant hydronephrosis, imaging for access, calyx for access, tract number, postoperative hemoglobin, hemoglobin drop and stone-free result. Renal dysfunction was accompanied by higher complications, yet the results were not statistically significant. Multivariate logistic regression analysis demonstrated renal dysfunction, absence of significant hydronephrosis, AUUTA, multiple tracts, lower postoperative hemoglobin, and higher postoperative hemoglobin drop as the significant parameters which affected MCC and predicted higher grades. The paper's limitations include a low number of cases in the higher Clavien grades and some subgroups of variables, and not applying some techniques due to surgeon preference. INTERPRETATION Many of the complete supine PCNL complications were in the lower Clavien grades and major complications were uncommon. Renal dysfunction, AUUTA, significant hydronephrosis, tract number, postoperative hemoglobin, and hemoglobin drop were the only factors affecting MCC.
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Affiliation(s)
- Siavash Falahatkar
- Urology Research Center, Guilan University of Medical Sciences; and the Razi Hospital, Rasht, Iran
| | | | - Ehsan Kazemnezhad
- Urology Research Center, Guilan University of Medical Sciences; and the Razi Hospital, Rasht, Iran
| | - Alireza Farzan
- Urology Research Center, Guilan University of Medical Sciences; and the Razi Hospital, Rasht, Iran
| | - Hamidreza Baghani Aval
- Urology Research Center, Guilan University of Medical Sciences; and the Razi Hospital, Rasht, Iran
| | - Ali Ghasemi
- Urology Research Center, Guilan University of Medical Sciences; and the Razi Hospital, Rasht, Iran
| | - Elaheh Shahab
- Urology Research Center, Guilan University of Medical Sciences; and the Razi Hospital, Rasht, Iran
| | | | - Reza Motiee
- Urology Research Center, Guilan University of Medical Sciences; and the Razi Hospital, Rasht, Iran
| | | | - Mohadeseh Nemati
- Urology Research Center, Guilan University of Medical Sciences; and the Razi Hospital, Rasht, Iran
| | - Aliakbar Allahkhah
- Urology Research Center, Guilan University of Medical Sciences; and the Razi Hospital, Rasht, Iran
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Koras O, Bozkurt IH, Yonguc T, Degirmenci T, Arslan B, Gunlusoy B, Aydogdu O, Minareci S. Risk factors for postoperative infectious complications following percutaneous nephrolithotomy: a prospective clinical study. Urolithiasis 2014; 43:55-60. [PMID: 25269441 DOI: 10.1007/s00240-014-0730-8] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 09/23/2014] [Indexed: 01/09/2023]
Abstract
The aim of the study was to assess the preoperative and intraoperative potential risk factors for infectious complications after percutaneous nephrolithotomy (PCNL). A total of 303 patients who underwent PCNL for renal stones were included in the recent study. A detailed history including past renal surgery, nephrostomy insertion and recurrent urinary infection were obtained from all patients. Preoperative urine culture, renal pelvic urine culture and stone culture were obtained from all patients. The intraoperative data were prospectively noted. All patients were followed up postoperatively for signs of systemic inflammatory response syndrome (SIRS) and sepsis. In 83 (27.4%) of the patients, SIRS was observed and of these patients 23 (7.6%) were diagnosed as sepsis. Escherichia coli was the most common organism detected in cultures, followed by Pseudomonas aeruginosa, Enterococcus and Klebsiella spp. in all patients. By multivariate logistic regression analysis, presence of infection stone, stone burden and recurrent urinary tract infection were associated with both SIRS and sepsis development. Presence of infection stone, stone burden ≥800 mm(2) and recurrent urinary tract infection can be identified as independent predictors for the development of SIRS and sepsis.
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Affiliation(s)
- Omer Koras
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
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43
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Intra-operative stone culture as an independent predictor of systemic inflammatory response syndrome after percutaneous nephrolithotomy. Urolithiasis 2014; 42:455-9. [DOI: 10.1007/s00240-014-0688-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 07/15/2014] [Indexed: 11/26/2022]
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Flannigan R, Choy WH, Chew B, Lange D. Renal struvite stones--pathogenesis, microbiology, and management strategies. Nat Rev Urol 2014; 11:333-41. [PMID: 24818849 DOI: 10.1038/nrurol.2014.99] [Citation(s) in RCA: 137] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Infection stones-which account for 10-15% of all urinary calculi-are thought to form in the presence of urease-producing bacteria. These calculi can cause significant morbidity and mortality if left untreated or treated inadequately; optimal treatment involves complete stone eradication in conjunction with antibiotic therapy. The three key principles of treating struvite stones are: removal of all stone fragments, the use of antibiotics to treat the infection, and prevention of recurrence. Several methods to remove stone fragments have been described in the literature, including the use of urease inhibitors, acidification therapy, dissolution therapy, extracorporeal shockwave lithotripsy, ureteroscopy, percutaneous nephrolithotomy (PCNL), and anatrophic nephrolithotomy. PCNL is considered to be the gold-standard approach to treating struvite calculi, but adjuncts might be used when deemed necessary. When selecting antibiotics to treat infection, it is necessary to acquire a stone culture or, at the very least, urine culture from the renal pelvis at time of surgery, as midstream urine cultures do not always reflect the causative organism.
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Affiliation(s)
- Ryan Flannigan
- The Stone Centre at Vancouver General Hospital, Jack Bell Research Centre, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada
| | - Wai Ho Choy
- The Stone Centre at Vancouver General Hospital, Jack Bell Research Centre, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada
| | - Ben Chew
- The Stone Centre at Vancouver General Hospital, Jack Bell Research Centre, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada
| | - Dirk Lange
- The Stone Centre at Vancouver General Hospital, Jack Bell Research Centre, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada
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Arneill M, Hennessey DB, Glackin AJ. The septic obstructed kidney: a urological emergency. Br J Hosp Med (Lond) 2014; 75:192-6. [PMID: 24727956 DOI: 10.12968/hmed.2014.75.4.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M Arneill
- F1 Trainee in the Department of Urology, Craigavon Area Hospital, Portadown, BT63 5QQ
| | - D B Hennessey
- Urology Specialty Trainee in the Department of Urology, Craigavon Area Hospital, Portadown, BT63 5QQ
| | - A J Glackin
- Urology Consultant in the Department of Urology, Craigavon Area Hospital, Portadown, BT63 5QQ
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Abstract
Since its introduction into the endourologist's armamentarium almost 40 years ago, percutaneous nephrolithotomy (PCNL) has become the standard of care for patients with large-volume nephrolithiasis. Postoperative infection is one of the most common complications of the procedure, and postoperative sepsis is one of the most detrimental. A number of factors have been found to increase the risk of postoperative sepsis. These include patient characteristics that are known preoperatively, such as urine culture obtained from the bladder or from the renal pelvis if percutaneous access to the renal pelvis is obtained in advance to the procedure. Neurogenic bladder dysfunction secondary to spinal cord injury and anatomical renal abnormalities, such as pelvicalyceal dilatation, have also been associated with increased incidence of fever and sepsis after the procedure. Several intraoperative factors, such as the average renal pressure sustained during PCNL and the operative time, also seem to increase the risk of sepsis. Finally, the contribution of postoperative factors, such as presence of a nephrostomy tube or a urethral catheter, has also been investigated. A short preoperative course of antibiotics has been found to significantly decrease the rate of postoperative fever and sepsis. Novel agents targeted at sepsis prevention and treatment, such as anti-endotoxin antibodies and cholesterol-lowering drugs statins, are currently under investigation.
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Erdil T, Bostanci Y, Ozden E, Atac F, Yakupoglu YK, Yilmaz AF, Sarikaya S. Risk factors for systemic inflammatory response syndrome following percutaneous nephrolithotomy. Urolithiasis 2013; 41:395-401. [PMID: 23712738 DOI: 10.1007/s00240-013-0570-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 05/16/2013] [Indexed: 11/25/2022]
Abstract
The aim of this study was to analyze the pre- and intraoperative risk factors that affect the development of postoperative systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL). Medical records on 317 adult patients with the complete data who underwent single-stage PCNL and followed at our center were retrospectively studied. Patients' data were collected through a database which was collected prospectively. All patients' vital signs were recorded hourly in the postoperative period and were divided into two groups as patients developing SIRS and not developing SIRS. There were 202 men and 115 women with a mean age of 48 ± 13.7 (range 19-82) years. There were 53 (16.7 %) in the SIRS and 264 (83.3 %) patients in the non-SIRS group. Preoperative positive urine cultures (UCs), intraoperative positive renal pelvic urine cultures (RPUCs), and stone cultures (SCs) were strongly correlated with the development of SIRS (p = 0.001). In the SIRS developers' group, preoperative UCs, intraoperative RPUCs, and SCs were positive in 33.9, 22.5, and 28.6 % of patients, respectively, but only 9.8, 3.3, and 4.2 % for the corresponding specimens in non-SIRS group. Positive preoperative UCs, intraoperative RPUCs, and SCs are important factors indicating the development of postoperative SIRS. Appropriately treated preoperative urinary infections may not prevent infected urine at PCNL. RPUCs and SCs may be the only way to identify the causative organism and direct antimicrobial therapy, so we recommend collecting RPUCs and SCs routinely to identify the offending organism and guide treatment.
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Affiliation(s)
- Tunc Erdil
- Department of Urology, Faculty of Medicine, Ondokuz Mayis University, 55139, Samsun, Turkey
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Seyrek M, Binbay M, Yuruk E, Akman T, Aslan R, Yazici O, Berberoglu Y, Muslumanoglu AY. Perioperative prophylaxis for percutaneous nephrolithotomy: randomized study concerning the drug and dosage. J Endourol 2012; 26:1431-6. [PMID: 22612061 DOI: 10.1089/end.2012.0242] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To compare sulbactam-ampicillin and cefuroxime antibiotics for prophylaxis of percutaneous nephrolithotomy (PCNL) and to find out the optimal regimen for antibiotic maintenance to prevent systemic inflammatory response syndrome (SIRS). PATIENTS AND METHODS Between February 2010 and March 2011, a total of 198 patients in whom PCNL was performed were prospectively randomized into two main groups regarding the type of prophylactic antibiotic (group1: sulbactam-ampicillin, group 2: cefuroxime). Each group was further randomized according to duration of antibiotic maintenance (a: single dose prophylaxis, b: additional dose 12 hours after prophylaxis, c: beginning with prophylactic dose until the nephrostomy tube removal). Seven patients in whom purulent urine was obtained through the access needle were excluded from the study. Groups were compared in terms of stone- and operation-related factors as well as preoperative urine cultures, access cultures, stone cultures, postoperative urine cultures, and presence of SIRS. RESULTS A total of 191 patients (group 1: 95, group 2: 96) were evaluated. Mean patient age, body mass index, stone size, and perioperative outcomes were similar. Positive culture rates did not differ between groups. SIRS was observed in 13 (43.3%) patients in group 1 and 17 patients (56.7%) in group 2 (P=0.44). The relation between duration of antibiotic maintenance and SIRS development was not different in each group (P=0.95 for group 1, P: 0.39 for group 2). Urosepsis was observed in two patients, and one patient died because of septic shock. CONCLUSIONS Sulbactam-ampicillin and cefuroxime antibiotics can be used safely for prophylaxis of PCNL. Single dose administration is sufficient.
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Affiliation(s)
- Mahir Seyrek
- Department of Urology, Haseki Teaching and Research Hospital, Istanbul, Turkey
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Kupajski M, Tkocz M, Ziaja D. Modern management of stone disease in patients with a solitary kidney. Wideochir Inne Tech Maloinwazyjne 2012; 7:1-7. [PMID: 23255993 PMCID: PMC3516964 DOI: 10.5114/wiitm.2011.25641] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Revised: 06/27/2011] [Accepted: 07/25/2011] [Indexed: 11/17/2022] Open
Abstract
Analysing the data available in the literature, contemporary methods of treatment of nephrolithiasis are limited to the methods of minimally invasive percutaneous nephrolithotomy (PCNL) and ureterorenoscopic lithotripsy (URSL), not excluding their use in the presence of developmental abnormalities and kidney impairment only. Minimally invasive methods have become standard procedures. A complement to ineffective URSL and PCNL treatment is extracorporeal shock wave lithotripsy. This is confirmed by 30 years of observation in the only treatment of kidney calculi by Alken launched in 1981 and continued by Jones et al. Before the era of endoscopic procedures (PCNL and URSL) effectively removed the only deposits in the kidney in open operations. Minimally invasive treatments are recommended for patients with localized deposits in the pelvicalyceal system or solitary kidney ureter. They are recognized as safe and effective treatment in a solitary kidney in particular in patients who have already been operated on.
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Affiliation(s)
- Maciej Kupajski
- Prof. E. Michałowski's Independent Health Care Facility, Katowice, Poland
| | - Michał Tkocz
- Prof. E. Michałowski's Independent Health Care Facility, Katowice, Poland
| | - Damian Ziaja
- Department of Vascular and General Surgery, Medical University of Silesia, Katowice, Poland
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Wang Y, Jiang F, Wang Y, Hou Y, Zhang H, Chen Q, Xu N, Lu Z, Hu J, Lu J, Wang X, Hao Y, Wang C. Post-percutaneous nephrolithotomy septic shock and severe hemorrhage: a study of risk factors. Urol Int 2012; 88:307-10. [PMID: 22378466 DOI: 10.1159/000336164] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 12/27/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To identify the risk factors predicting septic shock and severe hemorrhage in percutaneous nephrolithotomy (PCNL). METHODS We retrospectively analyzed 420 renal calculi patients who underwent ultrasound-guided PCNL from March 2005 to May 2011. Data on patients who experienced infectious shock requiring anti-shock therapy and severe renal bleeding requiring angiographic renal embolization or nephrectomy were compared with other patients using univariate analyses. RESULTS Of 420 patients, 10 (2.4%) suffered septic shock and 4 (1%) had severe hemorrhage. The two significant risk factors for infectious shock were preoperative urine white blood cell count and operation time. For severe bleeding the absence of hydronephrosis and puncture time were significant risk factors. Operation time >90 min was associated with both septic shock and severe renal bleeding (p = 0.017). In contrast, the risk of encountering severe renal bleeding was higher if a nephroscope rather than a ureteroscope was used (p = 0.045). CONCLUSIONS Operation time was a risk factor for both septic shock and severe hemorrhage. The patients without hydronephrosis before operation were more likely to suffer severe renal bleeding. Reducing intraoperative puncture time can reduce the probability of severe post-PCNL hemorrhage. The use of a comparatively gross nephroscope passage was likely to result in severe renal bleeding.
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Affiliation(s)
- Yanbo Wang
- Department of Urology, First Hospital of Jilin University, Changchun, People's Republic of China
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