Abstract
We are reporting the 39 patients’ outcomes who underwent percutaneous nephrolithotomy and purulent urine encountered at the initial steps of surgery. Of 873 patients who underwent PCNL, 48 had purulent fluid during the initial puncture. After excluding those at risk for infection, we studied 39 patients’ preoperative and postoperative variables-including postoperative day (POD) 1, 3, 5 fevers. In group 1, 21 patients had a nephrostomy tube placed, and PCNL was postponed. In group 2, 18 patients had successful stone removal in the first session. All surgeries were successful, with no septic events during follow-up. No significant differences in preoperative variables were found. 14% and 22% of patients in groups 1 and 2 had infected fluid (p = 0.470). Four patients in group 1 (19%) and seven patients in group 2 (38.9%) had a high fever (≥ 38 C) on POD1 (p = 0.171), and 1 (5%) in group 1 and 3 (17%) in group 2 had high fever on POD 3 (p = 0.22). No patients remained with high fever on POD5. Mild sepsis was diagnosed in 9.5% of group 1 and 16% of group 2 (p = 0.820), and hospitalization time differed significantly (p < 0.001). Stone size and operation time were correlated with postoperative fever, and prolonged hospital stays were associated with positive blood cultures and postponed procedures. PCNL with proper technique and antibiotics can lead to quicker recovery and reduced hospitalization time in selected patients with pus in their pelvicalyceal system.
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References
EAU-Guidelines-on-Urolithiasis-2023.pdf. https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Urolithiasis-2023.pdf
de la Rosette J, Assimos D, Desai M, Gutierrez J, Lingeman J, Scarpa R et al (2011) The clinical research office of the endourological society percutaneous nephrolithotomy global study: indications, complications, and outcomes in 5803 patients. J Endourol 25(1):11–17
Rivera M, Viers B, Cockerill P, Agarwal D, Mehta R, Krambeck A (2016) Pre—and postoperative predictors of infection-related complications in patients undergoing percutaneous nephrolithotomy. J Endourol 30(9):982–986
Bapir R, Bhatti KH, Eliwa A, García-Perdomo HA, Gherabi N, Hennessey D et al (2022) Infectious complications of endourological treatment of kidney stones: a meta-analysis of randomized clinical trials. Arch Ital Urol Androl Organo Uff Soc Ital Ecogr Urol E Nefrol 94(1):97–106
Liang X, Huang J, Xing M, He L, Zhu X, Weng Y et al (2019) Risk factors and outcomes of urosepsis in patients with calculous pyonephrosis receiving surgical intervention: a single-center retrospective study. BMC Anesthesiol 19(1):61
Lightner DJ, Wymer K, Sanchez J, Kavoussi L (2020) Best practice statement on urologic procedures and antimicrobial prophylaxis. J Urol 203(2):351–356
Vorrakitpokatorn P, Permtongchuchai K, Raksamani EO, Phettongkam A (2006) Perioperative complications and risk factors of percutaneous nephrolithotomy. J Med Assoc Thail Chotmaihet Thangphaet 89(6):826–833
Rao PN, Dube DA, Weightman NC, Oppenheim BA, Morris J (1991) Prediction of septicemia following endourological manipulation for stones in the upper urinary tract. J Urol 146(4):955–960
Zeng G, Zhong W, Pearle M, Choong S, Chew B, Skolarikos A et al (2022) European association of urology section of urolithiasis and international alliance of urolithiasis joint consensus on percutaneous nephrolithotomy. Eur Urol Focus 8(2):588–597
Doğan HS, Sahin A, Cetinkaya Y, Akdoğan B, Ozden E, Kendi S (2002) Antibiotic prophylaxis in percutaneous nephrolithotomy: prospective study in 81 patients. J Endourol 16(9):649–653
Draga ROP, Kok ET, Sorel MR, Bosch RJLH, Lock TMTW (2009) percutaneous nephrolithotomy: factors associated with fever after the first postoperative day and systemic inflammatory response syndrome. J Endourol 23(6):921–927
Aron M, Goel R, Gupta NP, Seth A (2005) Incidental detection of purulent fluid in kidney at percutaneous nephrolithotomy for branched renal calculi. J Endourol 19(2):136–139
Etemadian M, Haghighi R, Madineay A, Tizeno A, Fereshtehnejad SM (2008) Delayed versus same-day percutaneous nephrolithotomy in patients with aspirated cloudy urine. Urol J 5(1):28–33
Guo S, Zhang X, Li F, Sun C, Zhang Y, Cao X (2022) One-stage tubeless percutaneous nephrolithotomy for asymptomatic calculous pyonephrosis. BMC Urol 7(22):29
Hosseini MM, Basiri A, Moghaddam SMH (2007) Percutaneous nephrolithotomy of patients with staghorn stone and incidental purulent fluid suggestive of infection. J Endourol 21(12):1429–1432
Huang J, Song L, Xie D, Li M, Deng X, Hu M et al (2016) A randomized study of minimally invasive percutaneous nephrolithotomy (MPCNL) with the aid of a patented suctioning sheath in the treatment of renal calculus complicated by pyonephrosis by one surgery. BMC Urol 16(1):71
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M et al (2016) The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 315(8):801–810
Mariappan P, Loong CW (2004) Midstream urine culture and sensitivity test is a poor predictor of infected urine proximal to the obstructing ureteral stone or infected stones: a prospective clinical study. J Urol 171(6 Pt 1):2142–2145
Kreydin EI, Eisner BH (2013) Risk factors for sepsis after percutaneous renal stone surgery. Nat Rev Urol 10(10):598–605
Margel D, Ehrlich Y, Brown N, Lask D, Livne PM, Lifshitz DA (2006) Clinical implication of routine stone culture in percutaneous nephrolithotomy–a prospective study. Urology 67(1):26–29
Gonen M, Turan H, Ozturk B, Ozkardes H (2008) Factors affecting fever following percutaneous nephrolithotomy: a prospective clinical study. J Endourol 22(9):2135–2138
Gutierrez J, Smith A, Geavlete P, Shah H, Kural AR, de Sio M et al (2013) Urinary tract infections and post-operative fever in percutaneous nephrolithotomy. World J Urol 31(5):1135–1140
Chen L, Xu QQ, Li JX, Xiong LL, Wang XF, Huang XB (2008) Systemic inflammatory response syndrome after percutaneous nephrolithotomy: an assessment of risk factors. Int J Urol Off J Jpn Urol Assoc 15(12):1025–1028
Wang Y, Jiang F, Wang Y, Hou Y, Zhang H, Chen Q et al (2012) Post-percutaneous nephrolithotomy septic shock and severe hemorrhage: a study of risk factors. Urol Int 88(3):307–310
Seitz C, Desai M, Häcker A, Hakenberg OW, Liatsikos E, Nagele U et al (2012) Incidence, prevention, and management of complications following percutaneous nephrolitholapaxy. Eur Urol 61(1):146–158
Zhong W, Zeng G, Wu K, Li X, Chen W, Yang H (2008) Does a smaller tract in percutaneous nephrolithotomy contribute to high renal pelvic pressure and postoperative fever? J Endourol 22(9):2147–2151
Troxel SA, Low RK (2002) Renal intrapelvic pressure during percutaneous nephrolithotomy and its correlation with the development of postoperative fever. J Urol 168(4 Pt 1):1348–1351
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Dr.TS and Dr.EY Wrote the main manuscript. Dr. IS and Dr. MA helped with tables preparation and documents Dr. EY helped with the review and writing.
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Sipal, T., Senocak, I., Ataman, M. et al. Percutaneous nephrolithotomy in patients with incidental encountered purulent urine at initial puncture. Urolithiasis 51, 107 (2023). https://doi.org/10.1007/s00240-023-01481-z
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DOI: https://doi.org/10.1007/s00240-023-01481-z