ANALYSIS OF CAUSES, FREQUENCY AND SEVERITY OF ACUTE COMPLICATED PYELONEPHRITIS IN ENDOSCOPIC INTERVENTIONS FOR UROLITHIASIS

Abstract

Introduction . Despite the improvement of endoscopic equipment and methods of percutaneous and transurethral interventions on urolithiasis, acute pyelonephritis remains one of the most frequent postoperative complications. Purpose of the study . Objective assessment of frequency, causes and severity of postoperative pyelonephritis in endoscopic surgery for urolithiasis, as well as additional interventions needed to manage this complication. Materials and methods . The results of 1027 endoscopic operations (percutaneous and transurethral) performed in Republican Specialized Center of Urology (RSCU, Tashkent, Uzbekistan) for kidney and upper urinary tract stones were analyzed. «Simple» stones were in 446 (43.4%) patients, «complex» – in 581 (56.6%) ones. The severity of postoperative pyelonephritis were assessed using Clavien-Dindo grading system according to the necessity of additional interventions. Results . Postoperative pyelonephritis developed in 115 (11.2%) patients. According to the systematization of postoperative complications patients with pyelonephritis were distributed as follows: I-0, II-95, IIIa-8, IIIb10, IVa-2, IVb-0, V-0. Conclusions . Patients with initial urinary tract infection (UTI) and complications arising during endoscopic interventions and in postoperative period should be considered as «patients with absolute risk of postoperative infectious and inflammatory complications development». Complicated pyelonephritis was eradicated conservatively in 82.6% of patients, additional invasive interventions and intensive therapy were required in 17.4% of patients.