Factors determining postoperative infectious complications of percutaneous nephrolithotomy: Experience from a single centre

Abstract

Introduction: PCNL is considered the standard treatment for staghorn and large-volume renal calculi, as well as upper tract calculi refractory to other modalities, difficult lower pole stones, cystine nephrolithiasis, and calculi in anatomically abnormal kidneys. PCNL is typically a very safe and well-tolerated procedure, but as with any surgical intervention, PCNL is associated with a specific set of complications. Complication rates for PCNL reportedly range from 20-83%. The true complication rates of PCNL are difficult to determine and compare because most contemporary reviews of PCNL outcomes report only rates of specific complications of the procedure. PCNL technique has a steep learning curve and has certain complications specific to it. These include hemorrhage requiring transfusion, fever, sepsis, extravasation, pleural injury and colonic injury which can cause serious morbidity and mortality.Aims and objectives: To analyze the infectious complications following percutaneous nephrolithotomy(PCNL) and to assess factors responsible for these complications.Patients and methods: It is a retrospective study done at Department of Urology, Nizams Institute of Medical Sciences, Hyderabad. Patients who underwent PCNL between September 2016 and December 2018 were included in the study.Results: Out of total 320 patients, 64 (20%) developed features of systemic inflammatory response syndrome, 6 patients developed haemorrhage, 2 patients had pleural injury and 2 patients had colonic injury in the postoperative period. In the study population of 320 patients 128(40%) were females and 192(60%) were males. Among the males 35 (18.2%) developed SIRS and 31 (23.5%) females developed SIRS. Among the study population the mean stone size in patients who developed fever/sirs was 4.47(SD=±0.81) and the mean stone size in patients who didn’t have fever/SIRS was 3.78(SD=±0.94) On statistical analysis the difference in the mean size between both the groups for development of fever/SIRS is statistically significant (p<0.001). There was no statistically significance (p= 0.043) observed in patients between presence of growth in pre operative urine culture and sterile urine among patients who developed SIRS. It is observed that the chances of developing fever/SIRS is higher as the number of tracts increases and it is statistically significant (p<0.001). The proportion of patients developing fever/sirs appears to be high in patients with positive pelvic urine culture but it is not statistically insignificant (p=0.205).Conclusion: Statistical analysis showed significant association between stone size, number of calculi, pyelocaliectasis, number of access tracts, intra operative bleeding, intra operative time and post-operative blood transfusion for development of fever or SIRS. Diabetes mellitus, gender distribution, bladder urine culture showing growth, pelvic urine culture showing growth and stone culture showing growth are not significant predictors for development of SIRS.