Abstract
ObjectivesTo investigate whether the perioperatively combined application of dexamethasone and furosemide could alleviate the inflammation in patients undergoing percutaneous nephrolithotomy (PCNL).Patients and methods147 patients undergoing PCNL between November 2018 and October 2019 were enrolled in the study. 77 patients accepted a single dose of dexamethasone and furosemide administration (EXP group, n = 77), and 70 patients did not (CON group, n = 70). Demographic and perioperative data, inflammatory markers including interleukin-6 (IL-6) and procalcitonin (PCT), and clinical outcomes were compared between the two groups.ResultsCompared with the CON group, the incidence rate of urosepsis of the EXP group were significantly lower (11.69% vs. 24.29%, p = 0.046). 3 patients developed severe urosepsis in the EXP group, while 5 patients developed severe urosepsis in the CON group. Compared with those in the CON group, the patients with postoperative urosepsis in the EXP group showed lower serum levels of IL-6 at postoperative hour two (p = 0.045) and at postoperative day one (p = 0.031) and lower serum levels of PCT at postoperative day one (p = 0.015). There was a better clinical outcome of a shorter postoperative hospital stay (p = 0.015) in patients with postoperative urosepsis in the EXP group than in those in the CON group.ConclusionThe perioperatively combined application of dexamethasone and furosemide was beneficial for alleviating postoperative inflammatory reaction and caused a better clinical outcome of a shorter postoperative hospital stay.
Highlights
Urolithiasis is a common urological disease and affects people’s health with a prevalence of 5–10% worldwide[1, 2]
percutaneous nephrolithotomy (PCNL) has been regarded as the first-line approach for large, multiple renal calculi, especially for staghorn calculi, and is accepted by more and more urologists
Postoperative fever with a high incidence rate of 21–32.1% which may progress to potentially life-threatening urosepsis has been a great trouble for both patients and surgeons
Summary
Urolithiasis is a common urological disease and affects people’s health with a prevalence of 5–10% worldwide[1, 2]. The methods of urolithiasis were PCNL, ureteroscopic. International Urology and Nephrology (2021) 53:669–677 and increase mortality. There is a significantly stepwise increase in the mortality rate from SIRS to uroseptic shock. It is necessary to explore procedures that can alleviate infection-related complications and prevent the process of systemic infection. Dexamethasone, as one type of glucocorticoid, has a great anti-inflammatory effect, and furosemide has diuretic effect which may reduce the absorbing of bacteria and endotoxins. In the past clinical trials, we found the perioperative application of dexamethasone and furosemide might be helpful for anti-inflammation.
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