MP22-20 CLINICAL OUTCOMES OF PERCUTANEOUS NEPHROLITOTOMY IN PATIENTS WITH INCIDENTAL PURULENT URINE

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy I1 Apr 2016MP22-20 CLINICAL OUTCOMES OF PERCUTANEOUS NEPHROLITOTOMY IN PATIENTS WITH INCIDENTAL PURULENT URINE Miguel Villalobos-Gollas, Alexander Heinze, and Lizzette Gomez-de-Regil Miguel Villalobos-GollasMiguel Villalobos-Gollas More articles by this author , Alexander HeinzeAlexander Heinze More articles by this author , and Lizzette Gomez-de-RegilLizzette Gomez-de-Regil More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.708AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Percutaneous nephrolitotomy (PCNL) is today's standard of care for patients with kidney stones >20mm. When purulent urine is obtained during surgery it is advised to postpone surgery, take urine cultures, start antibiotics and to drain the urinary tract. Some have performed a standard PCNL with similar, although frequent, infectious complications. We aim to analyze perioperative surgical outcomes. METHODS We systematically reviewed all patients who underwent percutaneous nephrolitotomy (PCNL) in our center from June 2009 to May 2015. We reviewed patient files, lab results, stone characteristics, surgical findings and postoperative evolution. Complications were classified according to Clavien-Dindo scale. We divided the patients in 2 different groups according to urine characteristics. GFR was obtained before and after surgery using Chronic Kidney Disease Epidemiology Collaboration formula (CKD-EPI), and stratified into a subgroup of poor renal function according to KDIGO (Kidney Disease Improving Global Outcomes) stage 3 or more (GFR <60 mL/min). RESULTS A total of 285 patients were reviewed in the present study, in which 222 had clear urine (group 1) and 63 had purulent urine (group 2). No differences between groups were observed according to sociodemographic variables. Group 2 had significantly more patients KDIGO 3 or more (45.76% vs 24.74% in group 1, p=0.013), lower hemoglobin (11.87 vs 12.75 g/dL, p<0.001), lower GFR (57.0 vs 72.5 mL/min/1.73 m2 in group 1, p=0.002), and lower stone density (896 vs 1107 HU in group 1, p=0.001). Surgical aspects such as total surgical time and total nephroscopy time were longer in group 2 (192.8 vs 166.8 min, p=0.002 and 110.1 vs 93.1 min, p=0.034, respectively), Group 2 had a higher mean number of tracts (1.27 vs 1.09, p <.008). Postoperative tachypnea and tachycardia were more frequent in group 2 (25% and 37% vs 14% and 14%, p=0.029 and p <0.001, respectively) as were any grade CD surgical complications (40.7% vs 13.7%, p<0.001). CONCLUSIONS According to our results we cannot recommend performing PCNL in patients with cloudy or purulent aspiration because it is related with higher number of complications. Anemia and chronic renal disease are frequent in patients with incidental purulent urine © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e260 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Miguel Villalobos-Gollas More articles by this author Alexander Heinze More articles by this author Lizzette Gomez-de-Regil More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...