Post Percutaneous Nephrolithotomy Research Articles

Characteristics of Bacteria in Urine and Stones from Patients Treated with Percutaneous Nephrolithotomy and Association with Postoperative Infection.

The purpose of this study was to identify bacterial differences between urine cultures (UC) and stone cultures (SC) in patients with complex kidney stones and to determine any correlation with post-percutaneous nephrolithotomy Systemic Inflammatory Response Syndrome (SIRS). Perioperative data of 1055 patients with complex kidney stones treated with first-stage Percutaneous Nephrolithotomy (PCNL) from September 2016 until September 2021 were included. Preoperative mid-stream urine samples and surgically obtained stone material were subjected to bacterial culture and antibiotic sensitivity tests. Preoperatively, antibiotic usage was determined by the UC or local bacterial resistance patterns. After PCNL treatment, antibiotic selection was guided by stone bacterial culture result and clinical symptoms. The effect of different preoperative antibiotic regimens based on urine cultures and postoperative antibiotic treatment based on stone cultures were assessed. Positive stone cultures (SC+) were significantly more common than positive urine cultures (UC+) (31.9% vs 20.9%, p < 0.05). Escherichia coli (E. coli) was the most common uropathogen in both urine (54.3%) and stones (43.9%). The difference was statistically significant (p < 0.05). Moreover, UC+SC-, UC-SC+, UC+SC+, and preoperative serum creatinine were independent risk factors of postoperative SIRS. The incidence of SIRS in the UC+SC+ patients with different bacteria in stones and urine (51.6%) was higher than that in other culture groups. The antibiotic resistance of E. coli inside the stone was increased when prolonged preoperative antibiotics were administered to UC+ patients. The bacterial spectrum and positive outcome of culture in urine and stones were significantly different. The incidence of postoperative SIRS was highest in patients with UC+SC+ but with different bacteria strains. Prolonged pre-surgical antibiotic treatment apparently induced higher drug resistance for bacteria inside the stone.

Commentary on “develop a radiomics-based machine learning model to predict the stone-free rate post-percutaneous nephrolithotomy”

Commentary on “develop a radiomics-based machine learning model to predict the stone-free rate post-percutaneous nephrolithotomy”

STONE Score: A Predictor for Need of Blood Transfusion in Percutaneous Nephrolithotomy.

To determine if the STONE score is a predictor of blood transfusion and if patient-related factors, i.e., the presence of comorbidities such as urinary tract infection and obesity, can predict blood transfusion post-percutaneous nephrolithotomy. A cross-sectional descriptive study. Place and Duration of the Study: Department of Urology, The Aga Khan University Hospital, Karachi, Pakistan, between March 2022 and 2023. All patients admitted for percutaneous nephrolithotomy (PNCL) were included in the study. STONE score and patient related factors were assessed. Chi-square or Fisher's exact test was applied to check the association between the dependent variables (blood transfusion) and the independent variables. Logistic regression analysis was applied to compare the variables responsible for the outcome. Results: During the study period, 150 patients underwent PCNL. After exclusion, 89 patients were included in the study. The mean STONE score was 7.87, and the total number of transfusions was 8 (8.9%). BMI (body mass index) >25kg/m2 and STONE score were found to be significant factors predicting the need for transfusion with p-values of 0.02 and 0.03, respectively. On multivariate analysis, only BMI was found to be a significant contributing factor for blood transfusion. High BMI and STONE score are significant predictive factors for blood transfusion post-PCNL. Blood product arrangements should be restricted to obese patients. STONE score, Body mass index, Blood transfusion.

Develop a radiomics-based machine learning model to predict the stone-free rate post-percutaneous nephrolithotomy.

Radiomics and machine learning have been extensively utilized in the realm of urinary stones, particularly in forecasting stone treatment outcomes. The objective of this study was to integrate clinical variables and radiomic features to develop a machine learning model for predicting the stone-free rate (SFR) following percutaneous nephrolithotomy (PCNL).A total of 212 eligible patients who underwent PCNL surgery at the Second Affiliated Hospital of Nanchang University were included in a retrospective analysis. Preoperative clinical variables and non-contrast-enhanced CT images of all patients were collected, and radiomic features were extracted after delineating the stone ROI. Univariate analysis was conducted to identify clinical variables strongly correlated with the stone-free rate after PCNL, and the least absolute shrinkage and selection operator algorithm (lasso regression) was utilized to screen radiomic features. Four supervised machine learning algorithms, including Logistic Regression, Random Forest (RF), Extreme Gradient Boosting (XGBoost), and Gradient Boosting Decision Tree (GBDT), were employed. The clinical variables with strong correlation and screened radiomic features were integrated into the four machine learning algorithms to construct a prediction model, and the receiver operating curve was plotted. The area under the receiver operating curve (AUC), the accuracy rate, the specificity, etc., were used to evaluate the predictive performance of the four models.After analyzing postoperative statistics, the stone-free rate following the procedure was found to be 70.3% (n = 149). Among the various clinical variables examined, factors, such as stone number, stone diameter, stone CT value, stone location, and history of stone surgery, were identified as statistically significant in relation to the stone-free rate after PCNL. A total of 121 radiomic features were extracted, and through lasso regression, 7 features most closely associated with the stone-free rate post-PCNL were identified. The predictive accuracy of different models (Logistic Regression, RF, XGBoost, and GBDT) for determining the stone-free rate after PCNL was evaluated, yielding accuracies of 78.1%, 76.6%, 75.0%, and 73.4%, respectively. The corresponding area under the curve AUC (95%CI) were 0.85 (0.83-0.89), 0.81 (0.76-0.85), 0.82 (0.78-0.85), and 0.77 (0.73-0.81), positioning these models among the top performers in logistic regression prediction. In terms of predictive importance scores, the key factors identified by the logistic regression model were number of stone, zone percentage, stone diameter, and surface area. Similarly, the RF model highlighted number of stone, stone CT value, stone diameter, and surface area as the top predictors.Among the four machine learning models, the logistic regression model demonstrated the highest accuracy and discrimination ability in predicting the stone-free rate following PCNL. In comparison to XGBoost and GBDT, RF also exhibited superior accuracy and a certain level of discrimination ability. However, based on the performance of all four models, logistic regression is more likely to aid in clinical decision-making by assisting clinicians in diagnosing PCNL in patients. This enables us to effectively predict the presence of residual stones post-surgery and ultimately select patients who are suitable candidates for PCNL.

Construction and validation of the nomogram predictive model for post-percutaneous nephrolithotomy urinary sepsis.

This study aimed to construct and validate a simple and accurate clinical nomogram for predicting the occurrence of post-percutaneous nephrolithotomy sepsis, aiming to assist urologists in the early identification, warning, and early intervention of urosepsis, and to provide certain evidence-based medicine basis. This study included patients who underwent PCNL surgery due to kidney or upper ureteral stones at the Department of Urology, Affiliated Hospital of Zunyi Medical University, from January 2019 to September 2022. This study utilized univariate and multivariate logistic regression analysis to screen and evaluate the risk factors for sepsis and construct a predictive model. An evaluation was performed using the receiver operating characteristic curve, calibration curve, and decision curve analysis curve. All statistical analyses were conducted using R version 4.2. A total of 946 patients who underwent post-PCNL were included in this study, among whom 69 patients (7.29%) developed post-PCNL urinary sepsis. Multiple-factor logistic regression analysis identified four independent risk factors associated with post-PCNL urinary sepsis, including positive urinary nitrite (OR = 5.9, P < 0.001), positive urine culture (OR = 7.54, P < 0.001), operative time ≥ 120min (OR = 20.93, P = 0.0052), and stone size ≥ 30mm (OR = 13.81, P = 0.0015). The nomogram model demonstrated good accuracy with an AUC value of 0.909, and in the validation cohort, the AUC value was 0.922. The calibration curve indicated a better consistency between the predictive line chart and the actual occurrence of post-PCNL urinary sepsis. The decision curve analysis curve showed favorable clinical utility. Preoperative positive urine culture, positive urinary nitrite, operative time ≥ 120min, and stone size ≥ 30mm are independent risk factors for developing post-PCNL urinary sepsis. The constructed line chart based on these factors effectively assesses the risk of urinary sepsis in patients after PCNL.

A novel post-percutaneous nephrolithotomy sepsis prediction model using machine learning

ObjectivesTo establish a predictive model for sepsis after percutaneous nephrolithotomy (PCNL) using machine learning to identify high-risk patients and enable early diagnosis and intervention by urologists.MethodsA retrospective study including 694 patients who underwent PCNL was performed. A predictive model for sepsis using machine learning was constructed based on 22 preoperative and intraoperative parameters.ResultsSepsis occurred in 45 of 694 patients, including 16 males (35.6%) and 29 females (64.4%). Data were randomly segregated into an 80% training set and a 20% validation set via 100-fold Monte Carlo cross-validation. The variables included in this study were highly independent. The model achieved good predictive power for postoperative sepsis (AUC = 0.89, 87.8% sensitivity, 86.9% specificity, and 87.4% accuracy). The top 10 variables that contributed to the model prediction were preoperative midstream urine bacterial culture, sex, days of preoperative antibiotic use, urinary nitrite, preoperative blood white blood cell (WBC), renal pyogenesis, staghorn stones, history of ipsilateral urologic surgery, cumulative stone diameters, and renal anatomic malformation.ConclusionOur predictive model is suitable for sepsis estimation after PCNL and could effectively reduce the incidence of sepsis through early intervention.

Changes in renal volume post Percutaneous nephrolithotomy based on ultrasonography and its correlation with glomerular filtration rate (GFR).

Percutaneous nephrolithotomy (PCNL) is considered to be the gold standard management for renal calculi. The purpose of this study is to comprehend the overall alterations in renal volume occurring after PCNL. The changes in the kidney's total volume in individual patients will be examined by ultrasonography pre and postoperatively, and it will be correlated with GFR. It was a prospective observational study performed over 70 participants, conducted at the department of Urology of a tertiary care hospital in Eastern India. Each patients were evaluated with pre and post PCNL USG for kidney volume and GFR. The data was statistically evaluated by SPSS software. The preoperative and post operative calculated mean GFR was 96.030 ± 18.922 ml and 86.681 ± 16.938 ml,volume was 127.258 ± 25.705 and 123,678 ± 26.357 respectively . There was statistically significant decrease in GFR and volume following PCNL. It also shows that patients who underwent single puncture PCNL had significantly less decrease in GFR and kidney volume compared to multiple puncture PCNL. Moreover, the calculated mean change in GFR and volume were significantly less seen in single puncture-one step dilatation and single puncture-serial dilatation as compared to multiple puncture-one step dilatation and multiple puncture-serial dilatation. Our study showed that there was significant changes in the renal volume and GFR following PCNL . So, a sonographic estimation of renal dimensions and GFR calculation after PCNL will help in the prognosis and further follow up of patients. A Single puncture had a better operative outcome and less adverse consequences with respect to GFR, volume change and for renal function as compared to multiple puncture.

Development and validation of a predictive model for post-percutaneous nephrolithotomy urinary sepsis: a multicenter retrospective study.

The objective of this retrospective, multicenter study was to analyze the factors associated with the development of urogenital sepsis after percutaneous nephrolithotomy (PCNL) and to establish a nomogram prediction model of urogenital sepsis after PCNL. A total of 2066 postoperative PCNL patients were included from three medical institutions: Zunyi Medical University Hospital, Beijing Jishuitan Hospital Guizhou Hospital, and Fenggang County People's Hospital. Clinical data of 1623 patients from the Department of Urology of Zunyi Medical University Hospital were randomized into a training cohort (Zunyi training cohort, N.=1139) and an internal validation cohort (Zunyi internal validation cohort, N.=484) using computer generated random numbers in a 7:3 ratio. Univariate and multivariate logistic regression analyses were performed on the compliance training cohort to identify risk factors for urogenital sepsis after PCNL and to develop a column line graph prediction model based on these risk factors. Finally, Zunyi internal validation cohort and two external validation cohorts (Guiyang external cohort, N.=306; Fenggang external cohort, N.=137) were used to validate the prognostic accuracy of the nomogram prediction model. R4.2.2 statistical software was used for all statistical data analyses. Multifactorial logistic regression analysis of the Zuiyi training cohort (N.=1139) identified five independent risk factors associated with urogenital sepsis after PCNL, including urine culture positivity (odds ratio [OR]=5.29, P<0.001), urine nitrite positivity (OR=5.97, P<0.001), operation time ≥60 min (OR=4.4, P=0.0037), residual stone (OR=5.18, P<0.001), and size ≥30 mm (OR=3.22, P=0.0086). Nomogram were constructed based on these independent risk factors. The area under the curve (AUC) of the nomogram model was 0.907 in the in-progress sample and 0.948 after internal validation. The AUC of the model was 0.855 and 0.804 after external validation of the Guiyang external validation cohort and the Fenggang validation cohort, respectively, indicating good discrimination ability. The calibration curves of the nomogram showed good agreement, and the decision curve analysis demonstrated high clinical utility. Based on the clinical independent risk factors such as positive urine culture, positive urine nitrite, operation time ≥60min, stone residue, stone size ≥30mm, nomogram prediction model of urogenital sepsis after PCNL was established, which can provide reference for urologists to develop preoperative evaluation and treatment strategies for patients with percutaneous nephrolithotomy.

Comparison between different radiological scoring systems in predicting post-PCNL outcome

Background: Various scoring systems, including Guy's stone score (GSS), S.T.O.N.E. score, and Clinical Research Office of the Endourological Society (CROES) nomogram, have been assessed for predicting post-percutaneous nephrolithotomy (PCNL) success in terms of stone-free status (SFS) and complications. Our study aims to determine the optimal predictor of SFS among these systems and assess their efficacy in predicting perioperative factors and complications, using modified Clavien grade. Methods: This prospective hospital-based cohort study involved 107 patients aged ≥18 years who underwent standard PCNL (tract size &gt;24 Fr) within a year. GSS, S.T.O.N.E. score, and CROES nomogram were calculated using preoperative computed tomography (CT) scans. Comparisons between 'stone-free' and 'residual-stone' groups were statistically analyzed. Results: All parameters effectively predicted SFS. S.T.O.N.E. score exhibited excellent discriminatory power (AUC 0.844; 95% CI: 0.762-0.907), followed by GSS (AUC 0.756; 95% CI: 0.663-0.834) and CROES nomogram (AUC 0.749; 95% CI: 0.656-0.828). S.T.O.N.E. score, with an AUC of 0.844, proved the most accurate predictor at ≤7 cut-off. GUY's score correlated positively with operative time and hospital stay (correlation coefficient 0.403, 0.34). S.T.O.N.E. score also positively correlated with these factors (correlation coefficient 0.443, 0.37). CROES nomogram negatively correlated with operative time and hospital stay (correlation coefficient -0.374, -0.314). Conclusions: All scoring systems effectively predict post-PCNL SFS, with S.T.O.N.E. score being the most predictive. GSS and S.T.O.N.E. score associate significantly with operative time and hospital stay. Both GSS and S.T.O.N.E. score show significant associations with perioperative complications assessed by modified Clavien grade.

Predictive factors of delayed bleeding after percutaneous nephrolithotomy requiring angioembolization.

To investigate the predictive factors of delayed post-percutaneous nephrolithotomy (PCNL) haemorrhage because of arteriovenous fistula (AVF) or pseudoaneurysm (PA) and compare the factors between AVF and PA. This is a case-control study with a case-to-control ratio of 1:3. Out of 5077 patients who underwent PCNL from April 2015 to April 2018 in three different teaching hospitals, 113 had post-PCNL haemorrhages because of AVF and/or PA. Seventy-two patients met the inclusion criteria and entered the study as cases, while 216 patients without any postoperative complications were selected as controls. Of all 72 studied patients with complications after PCNL, 35 (48.6%) had AVF, and the rest had PA. The regression model revealed that a history of diabetes (odds ratio [OR]: 2.799, 95% confidence interval [CI]: 1.392-5.630, p-value =0.004) and renal anomalies (OR: 2.929, 95% CI: 1.108-7.744, p-value =0.03) were associated with developing delayed post-PCNL haemorrhage. However, no differences were seen between AVF and PA regarding selected variables (p-value >0.05). History of diabetes and renal anomalies were predictive factors for delayed post-PCNL haemorrhage, but no predictive factors were found to differentiate PA and AVF from one another.

Assessing the Preoperative Neutrophil-Lymphocyte Count Ratio's Predictive Ability for Postoperative Sepsis in Percutaneous Nephrolithotomy Patients

Background: The present study aimed to evaluate whether neutrophil lymphocyte count ratio (NLCR) can be used to detect post- PCNL sepsis.The objective of this study was to assess the potential of neutrophil-lymphocyte count ratio (NLCR) in detecting post-percutaneous nephrolithotomy (PCNL) sepsis. Methodology: The Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, conducted a cross-sectional study between 05-Oct-2019 to 04-April-2020. Patients of renal stone planned for PCNL, All adult patients of age 18-65 years, irrespective of gender, those with the preoperative total leukocyte count of between 4 and 12 x109 cells/L, and those patients with ASA class 1 were made to take part in the study. After involving the patients in the study, CT KUB was used to calculate stone size. Complete blood Count was done one week before PCNL and NLCR was calculated for all patients. After PCNL, patients were followed for 1 week. All the gathered information including demographic details (age, gender), preoperative findings (NLCR, Stone size, staghorn), intraoperative findings (operating time, tracts, blood transfusion) and postoperative findings (temperature, heart rate, respiratory rate, total leukocyte count, blood and urine cultures) was noted on a pre-designed Proforma. Results: In this study, a total of 256 patients with a mean age of 41.17±10.18 years and a mean stone size of 29.1±6.3 mm were evaluated. The patients' mean operative time was 62.28±8.85 minutes. The area under the curve (AUC) was 0.824 in the ROC analysis, with the ideal cut-off value of NLCR being 2.5. The sensitivity and specificity of NLCR in predicting sepsis after PCNL were 50.0% and 98.0%, respectively, while the positive predictive value (PPV) was 80% and the negative predictive value (NPV) was 95.02%. The diagnostic accuracy was found to be 94.1%. Conclusion: The risk of sepsis following percutaneous nephrolithotomy (PCNL) can be predicted with success using a cut-off value of ≥2.5 for neutrophil-lymphocyte count ratio (NLCR). Moreover, it is a simple, cost-effective, and noninvasive test and readily available in hospital laboratories. Keywords: neutrophil lymphocyte count ratio, sepsis, percutaneous nephrolithotomy

A prospective randomised double blinded study-to evaluate the analgesic efficacy of transmuscular quadratus lumborum block in percutaneous Nephrolithotomy via VAS score

Introduction: Before the advent of ultrasound guided regional anaesthesia, post-operative pain in percutaneous nephrolithotomy was mainly confined to opioid consumption and other analgesics. The use of Ultrasound in regional anaesthesia has facilitated the visualization of anatomical structures, needle advancement and the spread of local anaesthetic. This has led to the development and refinement of fascial plane blocks. Quadratus Lumborum block (QLB) facilitates early postoperative ambulation and reduction in length of hospital stay by effective postoperative analgesia. Methods: In this prospective, randomised, double blinded study, 66 patients scheduled for elective percutaneous nephrolithotomy (PCNL) between 2021 and 2022 were randomised, 33 patients to receive ultrasound guided QLB with 20 ml of 0.25% bupivacaine and 33 patients receive 20 ml of normal saline post intubation. During the postoperative period, each patient’s pain level was assessed by the Visual analog scale(VAS) score for pain: range 0-10 (0=no pain,10=worst pain ever).The VAS score at 15 mins,1hr, 2hr, 6hr,12hr, 24hr intervals, should be monitored. Results: VAS Score in Group A was less as compared to Group B. The difference was statistically significant at 15 min, 1h, 2h, 4h, 6h, 8h, 14h. Conclusion: Hence, ultrasound guided Transmuscular QLB had better analgesic efficacy in post PCNL surgery.

Coexisting pseudoaneurysm and arteriovenous fistula following percutaneous nephrolithotomy

Abstract Percutaneous Nephrolithotomy (PCNL) is a common and safe treatment for large kidney stones.Though several complications are reported.Renal hemorrhage is the most common complication after PCNL with a incidence of 11.2% to 17.5%.There have been reports of post PCNL bleeding attributable to AV fistulas and pseudoaneurysms. Massive bleeding can occur in the early postoperative period (2 to 14 days after PCNL), and arteriovenous fistula formation as a late complication usually 6 weeks after PCNL. A 45 yrs old gentleman presented with bilateral flank pain,right sided prone PCNL done. Then presented with post PCNL hematuria, angioemblosation done twice but again developed hematuria and diagnostic angiography done, and diagnosed as A-V fistula and coiling done. No post operative complications were seen. Angiography is the preferred method and has advantages as it can detect vascular lesions and immediately treated once they are detected.Early diagnosis and treatment of post PCNL hematuria is warrented to reduce morbidity and a successful outcome.

Superselective renal arterial embolization for severe postpercutaneous nephrolithotomy haemorrhage: clinical characteristics and risk factors for initial failure.

To identify the clinical characteristics of patients who underwent superselective renal arterial embolization (SRAE) after percutaneous nephrolithotomy (PCNL) and to explore the risk factors for failed initial SRAE after PCNL. Patients who underwent SRAE for severe haemorrhage following PCNL between January 2014 and December 2020 were included in the study. The clinical data of those patients and the parameters and characteristics of the perioperative PCNL and SRAE procedures were collected and analysed. A total of 243 patients were included in this study. A total of 139 patients (57.2%) had a pseudoaneurysm, 25 (10.3%) had an arteriovenous fistula, 50 (20.6%) patients had both a pseudoaneurysm and an arteriovenous fistula, and 29 (11.9%) had an arterial laceration. In 177 patients with single percutaneous access, 125 (70.6%) patients exhibited nontract haemorrhage, and 55 (31.1%) patients exhibited multiple bleeding sites. In 66 patients with multiple percutaneous access, 44 (66.7%) patients exhibited nontract haemorrhage, and 32 (48.5%) patients exhibited multiple bleeding sites. The decrease in Hb before SRAE was 41.4 ± 19.8g/L. The mean time between PCNL surgery and initial SRAE was 6.4 ± 4.9days. Serum creatinine was increased after the SRAE procedure. Initial SRAE was successful in 229 (94.2%) patients and failed in 14 (5.8%) patients. Multivariate regression demonstrated that hydronephrosis < 20mm, total ultrasonographic guidance, solitary kidney, previous ipsilateral renal surgery, PCNL duration > 90min and multiple bleeding sites were potential risk factors for initial embolization failure. Percutaneous access was not the most important reason for post-PCNL severe haemorrhage. SRAE is effective for the treatment of severe haemorrhage following PCNL; however, several factors have an impact on the success of initial SRAE. Additionally, the SRAE procedure may affect renal function.

Comparing the Effectivity of Intravenous Analgetic Tramadol and Intravenous Paracetamol for Acute Post-Percutaneous Nephrolithotomy

There are many management strategies and interventions both preoperative, intraoperative, and postoperative that can be carried out in dealing with postoperative pain. Guidelines for pain management have been prepared by the American Pain Society (APS) with recommendations from the American Society of Anesthesiologists (ASA) where there are many recommendations in postoperative pain management in adults or children by promoting the provision of preoperative education, the use of various modalities both pharmacological and non-pharmacological to the establishment of pain management procedures or policies in each institution. For this reason, the author was interested in examining the comparison of the effectiveness of analgesia between intravenous tramadol and intravenous Paracetamol in minimally invasive Percutaneous Nephrolithotomy (PCNL) postoperative patients at RSUP Dr. M. Djamil Padang. The research was a prospective study with a single-blind randomised controlled trial design. The data used were sourced from clinical trials conducted on post-PCNL patients divided into two subgroups given intravenous tramadol analgetics and others given Paracetamol tablets. In this study, the incidence of Nephrolithiasis was obtained, which was dominated by the male sex, compared to women and suffered a lot at the age of 41-60 years. There was a significant difference in VAS effectiveness between the use of Paracetamol IV and Tramadol IV in post-PCNL patients. The use of Paracetamol may be considered to replace tramadol in the disappearance of acute pain after PCNL postoperative patients in those patients who are allergic to tramadol.

Effect of alpha blockers on duration of urinary leakage post-percutaneous nephrolithotomy (PNL): a prospective randomized study

BackgroundUrinary leakage after removal of the nephrostomy tube post-percutaneous nephrolithotomy (PNL) is a common complication which could be secondary to ureteral stone fragments, blood clots, ureteral edema at the ureteropelvic or ureterovesical junction, or rupture calyx. Unfortunately, it could impact the patient’s hospital stay causing it to be lengthy, delaying time to return to work, and the negative psychological effect. The current study aimed at assessing the role and effectiveness of alpha blockers (tamsulosin) in minimizing the duration of urinary leakage post-percutaneous nephrolithotomy (PNL).MethodsIn this prospective randomized clinical study, 62 cases of PNL were included. Physical examination, laboratory investigations and radiological work up (KUB and plain computed tomography) were done. Cases were randomized into two equal groups: Group A (31 cases) received tamsulosin perioperatively; Group B (31 cases) did not receive tamsulosin. The two groups were followed postoperatively as regards duration of urinary leakage, urinary catheterization and hospital stay.ResultsDuration of urinary leakage was statistically significantly shorter in group A (10.61 ± 6.66 h) compared to group B (21.48 ± 12.41 h) (p-value ˂ 0.001). Similarly, duration of hospital stay was shorter in group A (2.52 ± 0.72 days) compared to group B (3.10 ± 0.98) (p-value 0.020).ConclusionsIn patients undergoing PNL for renal stones and receiving tamsulosin, the duration of urinary leakage, and eventually hospital stay was shorter compared to those not receiving tamsulosin.

Obstructing Ureteral Calculi and Presumed Infection: Impact of Antimicrobial Duration and Time From Decompression to Stone Treatment in Developing Urosepsis

To determine whether the duration of antibiotic treatment and timing between urgent renal decompression and stone intervention impacts the risk of developing urosepsis following definitive stone treatment. A retrospective review of patients who were diagnosed with obstructive urolithiasis and underwent urgent decompression with a ureteral double J stent or percutaneous nephrostomy at our institution between 2012 and 2018 was performed. We narrowed our analysis to the subset of patients who had suspected infection and received definitive stone treatment at our institution. Demographic, infection and antimicrobial data, and initial admission to stone treatment characteristics were collected. Factors associated with developing urosepsis were analyzed. We identified 872 patients who were treated with urgent renal decompression, of which 215 were analyzed that had suspected infection and also received definitive stone removal at our institution. Thirty-three had fevers, 64.2% had a positive urine culture, and 45.6% had urosepsis at the initial presentation. The median antibiotics duration post decompression was 13 days (IQR 8-18). The median duration from decompression to stone treatment was 17 days (IQR 12-27). Of all, 4.6% of the patients developed urosepsis post ureteroscopy and 5% post percutaneous nephrolithotomy. No factors were associated with developing urosepsis post stone treatment on logistic regression analyses. In patients requiring urgent decompression for obstructing urolithiasis and suspected infection, the time between decompression and stone treatment and the length of antibiotic exposure did not impact rates of postoperative urosepsis. This highlights the importance of maintaining high clinical suspicion for prolonged use of antibiotics, to prevent overtreatment and possible exacerbation of antibiotic resistance.

A1023 - Delayed post-percutaneous nephrolithotomy hemorrhage: Are there any predictive factors difference between Arteriovenous fistula (AVF) and Pseudoaneurysm (PA)? A three-year Multicentric case-control study

A1023 - Delayed post-percutaneous nephrolithotomy hemorrhage: Are there any predictive factors difference between Arteriovenous fistula (AVF) and Pseudoaneurysm (PA)? A three-year Multicentric case-control study

Infectious complications during the initial 225 cases of standard PCNL: A single center experience

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.

MP65-09 IMPACT OF PERI-OPERATIVE ANTIBIOTIC CHOICE ON INFECTIOUS COMPLICATIONS AFTER PCNL - A PROSPECTIVE RANDOMIZED TRIAL

You have accessJournal of UrologyStone Disease: Surgical Therapy V (MP65)1 Sep 2021MP65-09 IMPACT OF PERI-OPERATIVE ANTIBIOTIC CHOICE ON INFECTIOUS COMPLICATIONS AFTER PCNL - A PROSPECTIVE RANDOMIZED TRIAL Henry Wright, Naveen Kachroo, Rajat Jain, Omar Mohammed, Donald Fedrigon, Anna Zampini, Smita De, Mark Noble, Manoj Monga, Wahib Isac, and Sri Sivalingam Henry WrightHenry Wright More articles by this author , Naveen KachrooNaveen Kachroo More articles by this author , Rajat JainRajat Jain More articles by this author , Omar MohammedOmar Mohammed More articles by this author , Donald FedrigonDonald Fedrigon More articles by this author , Anna ZampiniAnna Zampini More articles by this author , Smita DeSmita De More articles by this author , Mark NobleMark Noble More articles by this author , Manoj MongaManoj Monga More articles by this author , Wahib IsacWahib Isac More articles by this author , and Sri SivalingamSri Sivalingam More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002105.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The American Urological Association guidelines recommend peri-procedural antibiotics for percutaneous nephrolithotomy (PCNL), yet it is not clear which is superior. Given the risk of infectious complications after PCNL, we prospectively compared two common antibiotics: ciprofloxacin (cipro) versus cefazolin, on PCNL outcomes, focusing on the presence of systemic inflammatory response syndrome (SIRS) criteria. We hypothesized that the use of cipro will result in less infectious complications due to its broader spectrum for UTI coverage. METHODS: Adult patients undergoing PCNL were randomized to receive either cipro or cefazolin peri-operatively. All had negative pre-operative urine cultures. Demographic and peri-operative data were collected, including SIRS criteria, intra-operative urine culture, duration of hospitalization, and need for intensive care. SIRS is defined by ≥2 of the following: body temperature < 96.8 °F or >100.4 °F, heart rate > 90 bpm, respiratory rate >20 per minute, WBC count <4000 or > 12,000 cells/mm³. Wilcoxon-Mann-Whitney was used to compare continuous variables and a Chi-square test or Fisher’s exact test was used to compare categorical variables. All statistical analysis was performed using SPSS version 26 (IBM). RESULTS: One hundred twenty-two patients were enrolled and randomized (69 cefazolin, 53 cipro). Mean age was higher in the cipro group (61 vs. 57, p=0.02). All other pre-operative characteristics were similar (p>0.05). Intra and post-operative findings were similar, with no difference between groups (p>0.05), including the number of patients meeting SIRS criteria. There were 3 positive intra-operative urine cultures in the cefazolin group, versus none in the cipro group, although this was not significant (p=0.26). One patient required intensive care in the cipro group, versus none in the cefazolin group. There were no Clavien-Dindo ≥3 complications, and no adverse reactions to either antibiotic. CONCLUSIONS: Despite the relatively broader coverage for urinary tract pathogens with cipro, this prospective trial did not show superiority over cefazolin. Accordingly, we reject our hypothesis as this data shows cefazolin and cipro appear to have equal effects on post PCNL SIRS outcomes, allowing for more options with peri-operative antibiotic prophylaxis. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1122-e1122 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Henry Wright More articles by this author Naveen Kachroo More articles by this author Rajat Jain More articles by this author Omar Mohammed More articles by this author Donald Fedrigon More articles by this author Anna Zampini More articles by this author Smita De More articles by this author Mark Noble More articles by this author Manoj Monga More articles by this author Wahib Isac More articles by this author Sri Sivalingam More articles by this author Expand All Advertisement Loading ...