Best Practices & Benign Disease
Introduction & Objective : Percutaneous nephrolithotomy (PCNL) is recommended for clearance of large stones. Post-PCNL sepsis can be a devastating sequela, and risk factors including diabetes mellitus, positive urine cultures, staghorn stones, and pre-existing nephrostomy tubes have been previously explored. We sought to explore other suspected risk factors for Post-PCNL sepsis.
Methods : The records of 147 consecutive PCNL procedures for nephrolithiasis between January and August 2015 were reviewed. We summarized demographics, medical history, and the presence of post-operative sepsis (two or more criteria of the systemic inflammatory response syndrome). We hypothesized that endoscopic intervention within the last year, central nervous system (CNS) impairments, history of UTI or urosepsis, ipsilateral PCNL, urinary diversion, preoperative nephrostomy or stent, and positive intraoperative stone cultures would increase the risk of sepsis. We speculated having documented clearance of a prior infection and “tubeless” PCNL (post-op stent or ureteral catheter without nephrostomy tube) would be associated with less risk of sepsis. We compared patients who did and did not develop sepsis with univariate analysis using SPSS version 23.0.
Results : In total, 140 operations met the inclusion criteria. Thirteen patients (9.3%) met sepsis criteria. Mean age (60.5 vs. 57.9), BMI (28.7 vs. 31.2), and hemoglobin A1c (5.5 vs. 6.4) did not differ significantly sepsis vs. no sepsis groups respectively. Results are summarized in Table 1. Only having CNS abnormalities showed statistically significant increased risk of sepsis. No patients with sepsis had an ipsilateral PCNL, urinary diversion, or pre-op nephrostomy tube. Other variables with large effect size were history of UTI, positive intra-op cultures, “tubeless” PCNL, and clearance of prior infection.
Conclusions : PCNL can be performed safely in patients with recent endoscopic intervention, treated infections, or reoperations on the same kidney. A pre-existing stent or positive stone culture does not significantly increase the risk of sepsis. Low sepsis rates for “tubeless” PCNL may be confounded by decreased case complexity. Patients with CNS deficits are at increased risk of post-PCNL sepsis and should be counseled appropriately.