Abstract
Introduction: Percutaneous 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.
Highlights
Kidney stone is one of the most common urological FRQGLWLRQ LQ 1HSDO1 The increasing adaptation to modern lifestyle, growing metabolic disease and infection has VLJQL¿FDQWO\ FRQWULEXWHG WR LQFUHDVH LQ LWV SUHYDOHQFH2 Health and economic burden due to stone disease is enormous[3] and its management in developing countries like 1HSDO LV D FKDOOHQJLQJ WDVN 7KH UHFHQW DGYDQFHPHQW DQG innovative technology have revolutionized the treatment of urinary stones.[4]
The mainstream treatment of stone disease has largely shifted to minimally invasive techniques. 3HUFXWDQHRXV QHSKUROLWKRWRP\ 3&1/ KDV HPHUJHG DV the treatment of choice for medium to large stones located PDLQO\LQWKHNLGQH\DQGWKHSUR[LPDOXUHWHU,WR൵HUVKLJK VXFFHVV UDWH DQG H[FHOOHQW VWRQH FOHDUDQFH UDWH %XW 3&1/ LV DVVRFLDWHG ZLWK VLJQL¿FDQW PRUELGLW\5,6 and septicemia remains one of the major complications associated with 3&1/,QIHFWLYH FRPSOLFDWLRQ KDV EHHQ UHSRUWHG WR RFFXU LQFDVHVRI3&1/7 Infective complication depends upon the infective status of urine, status of stone harboring bacteria, skill and experience of surgeon and case volume of the center
Kidney stones obstruct the pelvicalyceal system and bacteria may enter into the circulation during stone manipulation
Summary
Kidney stone is one of the most common urological FRQGLWLRQ LQ 1HSDO1 The increasing adaptation to modern lifestyle, growing metabolic disease and infection has VLJQL¿FDQWO\ FRQWULEXWHG WR LQFUHDVH LQ LWV SUHYDOHQFH2 Health and economic burden due to stone disease is enormous[3] and its management in developing countries like 1HSDO LV D FKDOOHQJLQJ WDVN 7KH UHFHQW DGYDQFHPHQW DQG innovative technology have revolutionized the treatment of urinary stones.[4]. If no residual stone was seen, the QHSKURVWRP\WXEHZDVUHPRYHG)ROH\FDWKHWHUZDVUHPRYHG WKH QH[W GD\ 5RXWLQHO\ WKH GRXEOH - VWHQW ZDV UHPRYHG two weeks after the procedure, but removed immediately if '-VWHQWUHODWHGIHYHUZDVREVHUYHG&OLQLFDOO\,QVLJQL¿FDQW 5HVLGXDO)UDJPHQWV &,5) DUHWKRVHUHVLGXDOFDOFXOLZKLFK DUHPPLQVL]HDV\PSWRPDWLFQRQREVWUXFWLYHDQGQRQ infectious.[13]. DQG WKH VWXG\ YDULDEOHV VH[ ORFDWLRQ RI VWRQH VWDWXV RI hydronephrosis, urine culture status, duration of surgery and QXPEHURIDFFHVVWRNLGQH\ ZHUHUHFRUGHGLQDSURIRUPD Patients above 18 years of age were included in the study. )HPDOHVH[SRVLWLYHXULQHFXOWXUHLQSUHRSHUDWLYHVDPSOH upper ureteric stone, severe hydronephrosis, multiple tract access, diabetic patient, longer duration of surgery DQG LQLWLDO FDVHV ZHUH VWDWLVWLFDOO\ VLJQL¿FDQW IRU WKH GHYHORSPHQWRILQIHFWLYHFRPSOLFDWLRQV Table 3
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