Category: Clinical Stones: PCNL

MP7-8 - Higher risk for PCNL sepsis in emergency patients with large stone burden and pre-op urine infection

Fri, Sep 21
10:00 AM - 12:00 PM

Introduction & Objective : Predicting risk for post operative sepsis in patients undergoing percutaneous nephrolithotomy has been an inexact science. Increasing incidence has been noted worldwide of post-operative sepsis. Various factors have been reviewed to understand the association with SIRS and to be able to pre-emptively predict high risk patients and garner appropriate pre-op optimisation protocols with adequate antibiotic pre-loading.

Methods : Over a 5-year period ending December 2016, 348 patients who underwent PCNL were reviewed. Patients who developed SIRS were identified. Intraoperative and postoperative factors were compared between the patients who developed SIRS and those who had an uneventful recovery. For the comparison of proportions chi-square and Fisher's exact test were used. Student's t-test was computed for the comparison of mean values between two groups.

Results : Averge age was 55.4 years (range:18-92) with an almost equal gender distribution (M:F=1:0.9). 27% of the patients developed SIRS. Average preoperative eGFR was 69 (SD=18.8). 37% had a positive preoperative mid-stream urine sample (MSU). 18% of patients had had an acute admission for pain or infection with a fifth being diabetic. 161 (47%) patients had a stone size >2 cm, and 114 (33%) had a staghorn stone. Contralateral stones were present in a third of patients. SIRS was more frequent in women as compared to men (35.2% vs. 19.8%, p=0.001), in patients with a positive preoperative MSU (39% vs. 21.3%, p=0.001) and in those with contralateral stone (35.4% vs. 23.5%, p=0.020). Preoperative emergency admission (p=0.005) and staghorn stone (p=0.022) was found to be associated with greater incidence of SIRS. Additionally, PCNL stone size >2 cm was found to be associated with greater risk of developing SIRS (p=0.007).

Conclusions : Large stones (Stone >2cms, Staghorn, female gender, preoperative positive MSU and preoperative emergency admission were found to be associated with increased risk of developing SIRS post PCNL suggesting the need to optimise post operative care and predictive antibiotics based on available microbiology.

Stefanos Bolomytis

Locum Consultant Urological Surgeon
Bristol Urological Institute, North Bristol NHS TRUST
Bristol, England, United Kingdom

Renata Harding

Department of Urology, Bristol Urological Institute
Bristol, England, United Kingdom

Anthony Timoney

Department of Urology, Bristol Urological Institute
Bristol, England, United Kingdom

Francis Keeley

Consultant Urological surgeon
Bristol Urological Institute, Southmead Hospital, Bristol, UK
Bristol, England, United Kingdom

Kim Jacobson

Department of Microbiology, Southmead Hospital, North Bristol NHS Trust
Bristol, England, United Kingdom

Neil Collin

Department of Radiology, Southmead Hospital, North Bristol NHS Trustth Bristol NHS Trust
Bristol, England, United Kingdom

Joe Philip

Consultant Urologist
North Bristol NHS Hospital NHS trust
Bristol, England, United Kingdom