Infectious complications during the initial 225 cases of standard PCNL: A single center experience
Abstract
IntroductionPercutaneous nephrolithotomy(PCNL) has emerged as the treatment of choice for medium to large urinary stones. Infection is a life threatening complication and is the most common cause of death following PCNL. This study aimed to examine different predictors of infective complications in PCNL.
Methods
This retrospective study was done on patients who underwent PCNL between 2016 and 2020 at a tertiary level medical college hospital. Medical records were reviewed for study variables.
Results
Two hundred and twenty five cases were included out of which 121 were male. A total of 151 complications were recorded among which 27(17.88%) were major complications. Infectious complications were seen in 67 (29.77%) patients among which 39 cases (17.33%) were febrile urinary tract infections. Urosepsis developed in four patients and one patient died due to urosepsis related complication. Female (p=0.003), Diabetes mellitus (p=0.002), positive urine culture (p=0.0001), stone location (p=0.01), degree of hydronephrosis (p=0.001), duration of surgery (p=0.001), number of access tracts (p=0.0001), and initial 100 cases (p=0.001) were associated with post PCNL infections.
Conclusion
Female, Diabetes mellitus, preoperative urine culture positivity, stone location, degree of hydronephrosis, duration of the operation, number of access tracts and surgeon experience are risk factors for post PCNL infections. Surgeons should be extra vigilant during their initial period. Urinary tract infection should be treated and extra care should be taken when operating in female patients giving ample attention to preoperative investigations.
References
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22. Song Y, Ma YN, Song YS, Fei X. Evaluating the Learning Curve for Percutaneous Nephrolithotomy under Total Ultrasound Guidance. PLoS One. 2015 Aug;10(8): e0132986.
23. Wu C, Hua LX, Zhang JZ, Zhou XR, Zhong W, Ni HD. Comparison of renal pelvic pressure and postoperative fever incidence between standard- and mini-tract percutaneous nephrolithotomy. Kaohsiung J Med Sci. 2017 Jan;33(1):36–43.
24. Yamaguchi A, Skolarikos A, Buchholz NPN, Chomón GB, Grasso M, Saba P, et al. Operating times and bleeding complications in percutaneous nephrolithotomy: a comparison of tract dilation methods in 5,537 patients in the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study. J Endourol. 2011 Jun;25(6):933–9.
25. Sugihara T, Yasunaga H, Horiguchi H, Fujimura T, Nishimatsu H, Kume H, et al. Longer operative time is associated with higher risk of severe complications after percutaneous nephrolithotomy: analysis of 1511 cases from a Japanese nationwide database. Int J Urol. 2013;20(12):1193–8.
26. Ganpule AP, Desai M. Management of the staghorn calculus: Multiple-tract versus single-tract percutaneous nephrolithotomy. Curr Opin Urol. 2008 Mar;18(2):220–3.
27. Liang T, Zhao C, Wu G, Tang B, Luo X, Lu S, et al. Multi-tract percutaneous nephrolithotomy combined with EMS lithotripsy for bilateral complex renal stones: our experience. BMC Urol. 2017 Feb;17(1):1–5.
28. Lai WS, Assimos D. Factors Associated With Postoperative Infection After Percutaneous Nephrolithotomy. Rev Urol. 2018;20(1):7–11.
29. Gücük A, Üyetürk U, Öztürk U, Kemahli E, Yildiz M, Metin A. Does the Hounsfield unit value determined by computed tomography predict the outcome of percutaneous nephrolithotomy? J Endourol. 2012 Jul;26(7):792–6.
30. Wishahi M, Elganzoury H, Elkhouly A, Kamal AM, Badawi M, Eseaily K, et al. Computed tomography versus plain radiogram in evaluation of residual stones after percutaneous nephrolithotomy or pyelonephrolithotomy for complex multiple and branched kidney stones. J Egypt Soc Parasitol. 2015 Aug;45(2):321–4.
31. Singh I, Shah S, Gupta S, Singh NP. Efficacy of Intraoperative Renal Stone Culture in Predicting Postpercutaneous Nephrolithotomy Urosepsis/Systemic Inflammatory Response Syndrome: A Prospective Analytical Study with Review of Literature. J Endourol. 2019 Feb;33(2):84–92.
2. Akman T, Binbay M, Erbin A, Tepeler A, Sari E, Kucuktopcu O, et al. The impact of metabolic syndrome on long-term outcomes of percutaneous nephrolithotomy (PCNL). BJU Int. 2012 Dec;110(11C):E1079-83.
3. Lotan Y, Jiménez IB, Lenoir-Wijnkoop I, Daudon M, Molinier L, Tack I, et al. Primary prevention of nephrolithiasis is cost-effective for a national healthcare system. BJU Int. 2012 Dec;110(11C):E1060-7.
4. Atassi N, Knoll T. Future of kidney stone management: surgical intervention miniaturization of PCNL: where is the limit? Curr Opin Urol. 2020 Mar 1;30(2):107–12.
5. Fuller A, Razvi H, Denstedt JD, Nott L, Hendrikx A, Luke M, et al. The clinical research office of the endourological society percutaneous nephrolithotomy global study: Outcomes in the morbidly obese patient - a case control analysis. Can Urol Assoc J. 2014;8(5–6):e393-7.
6. Rashid AO, Fakhulddin SS. Risk factors for fever and sepsis after percutaneous nephrolithotomy. Asian J Urol. 2016 Apr;3(2):82–7.
7. Wollin DA, Preminger GM. Percutaneous nephrolithotomy: complications and how to deal with them. Urolithiasis. 2018 Feb;46(1):87–97.
8. Sharma K, Sankhwar S, Goel A, Singh V, Sharma P, Garg Y. Factors predicting infectious complications following percutaneous nephrolithotomy. Urol Ann. 2016 Oct-Dec;8(4):434-38.
9. Koras O, Bozkurt IH, Yonguc T, Degirmenci T, Arslan B, Gunlusoy B, et al. Risk factors for postoperative infectious complications following percutaneous nephrolithotomy: a prospective clinical study. Urolithiasis. 2015 Feb;43(1):55–60.
10. Dogan HS, Guliyev F, Cetinkaya YS, Sofikerim M, Ozden E, Sahin A. Importance of microbiological evaluation in management of infectious complications following percutaneous nephrolithotomy. Int Urol Nephrol. 2007 Sep;39(3):737–42.
11. Ng CF. Training in percutaneous nephrolithotomy: The learning curve and options. Arab J Urol 2014;12(1):54–7.
12. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004 Aug;240(2):205–13.
13. Muslumanoglu AY, Tefekli A, Karadag MA, Tok A, Sari E, Berberoglu Y. Impact of Percutaneous Access Point Number and Location on Complication and Success Rates in Percutaneous Nephrolithotomy. Urol Int. 2006 Nov;77(4):340–6.
14. Gutierrez J, Smith A, Geavlete P, Shah H, Kural AR, de Sio M, et al. Urinary tract infections and post-operative fever in percutaneous nephrolithotomy. World J Urol. 2013 Oct;31(5):1135–40.
15. McAleer IM, Kaplan GW, Bradley JS, Carroll SF, Griffith DP. Endotoxin content in renal calculi. J Urol. 2003 May;169(5):1813–4.
16. Pandey S, Sharma D, Sankhwar S, Singh M, Garg G, Aggarwal A, et al. Are there any predictive risk factors for failure of ureteric stent in patients with obstructive urolithiasis with sepsis? Investig Clin Urol. 2018;59(6):371–5.
17. Wang S, Yuan P, Peng E, Xia D, Xu H, Wang S, et al. Risk Factors for Urosepsis after Minimally Invasive Percutaneous Nephrolithotomy in Patients with Preoperative Urinary Tract Infection. Biomed Res Int. 2020;2020: 1354672.
18. Korets R, Graversen JA, Kates M, Mues AC, Gupta M. Post-percutaneous nephrolithotomy systemic inflammatory response: a prospective analysis of preoperative urine, renal pelvic urine and stone cultures. J Urol. 2011;186(5):1899–903.
19. Aghdas FS, Akhavizadegan H, Aryanpoor A, Inanloo H, Karbakhsh M. Fever after percutaneous nephrolithotomy: contributing factors. Surg Infect (Larchmt). 2006 Aug;7(4):367–71.
20. Xun Y, Yang Y, Yu X, Li C, Lu J, Wang S. A preoperative nomogram for sepsis in percutaneous nephrolithotomy treating solitary, unilateral and proximal ureteral stones. PeerJ. 2020;8:e9435.
21. Wei W, Leng J, Shao H, Wang W. Diabetes, a risk factor for both infectious and major complications after percutaneous nephrolithotomy. Int J Clin Exp Med. 2015 Sep;8(9):16620.
22. Song Y, Ma YN, Song YS, Fei X. Evaluating the Learning Curve for Percutaneous Nephrolithotomy under Total Ultrasound Guidance. PLoS One. 2015 Aug;10(8): e0132986.
23. Wu C, Hua LX, Zhang JZ, Zhou XR, Zhong W, Ni HD. Comparison of renal pelvic pressure and postoperative fever incidence between standard- and mini-tract percutaneous nephrolithotomy. Kaohsiung J Med Sci. 2017 Jan;33(1):36–43.
24. Yamaguchi A, Skolarikos A, Buchholz NPN, Chomón GB, Grasso M, Saba P, et al. Operating times and bleeding complications in percutaneous nephrolithotomy: a comparison of tract dilation methods in 5,537 patients in the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study. J Endourol. 2011 Jun;25(6):933–9.
25. Sugihara T, Yasunaga H, Horiguchi H, Fujimura T, Nishimatsu H, Kume H, et al. Longer operative time is associated with higher risk of severe complications after percutaneous nephrolithotomy: analysis of 1511 cases from a Japanese nationwide database. Int J Urol. 2013;20(12):1193–8.
26. Ganpule AP, Desai M. Management of the staghorn calculus: Multiple-tract versus single-tract percutaneous nephrolithotomy. Curr Opin Urol. 2008 Mar;18(2):220–3.
27. Liang T, Zhao C, Wu G, Tang B, Luo X, Lu S, et al. Multi-tract percutaneous nephrolithotomy combined with EMS lithotripsy for bilateral complex renal stones: our experience. BMC Urol. 2017 Feb;17(1):1–5.
28. Lai WS, Assimos D. Factors Associated With Postoperative Infection After Percutaneous Nephrolithotomy. Rev Urol. 2018;20(1):7–11.
29. Gücük A, Üyetürk U, Öztürk U, Kemahli E, Yildiz M, Metin A. Does the Hounsfield unit value determined by computed tomography predict the outcome of percutaneous nephrolithotomy? J Endourol. 2012 Jul;26(7):792–6.
30. Wishahi M, Elganzoury H, Elkhouly A, Kamal AM, Badawi M, Eseaily K, et al. Computed tomography versus plain radiogram in evaluation of residual stones after percutaneous nephrolithotomy or pyelonephrolithotomy for complex multiple and branched kidney stones. J Egypt Soc Parasitol. 2015 Aug;45(2):321–4.
31. Singh I, Shah S, Gupta S, Singh NP. Efficacy of Intraoperative Renal Stone Culture in Predicting Postpercutaneous Nephrolithotomy Urosepsis/Systemic Inflammatory Response Syndrome: A Prospective Analytical Study with Review of Literature. J Endourol. 2019 Feb;33(2):84–92.
Published
2022-02-02
How to Cite
KARKI, Kushal; BHUSAL, Narayan.
Infectious complications during the initial 225 cases of standard PCNL: A single center experience.
J Soc Surg Nep, [S.l.], v. 24, n. 2, p. 51-57, feb. 2022.
ISSN 2392-4772.
Available at: <https://jssn.org.np/index.php?journal=jssn&page=article&op=view&path%5B%5D=489>. Date accessed: 03 dec. 2024.
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