Category: Clinical Stones: PCNL
Introduction & Objective :
Post-percutaneous nephrolithotomy (PCNL) systemic inflammatory response syndrome (SIRS) is ≈5% and despite antibiotic administration can be a life-threatening event. Strategies to prevent SIRS and infectious complications are based on preoperative and postoperative urine cultures. In this study we evaluated the concordance of stone culture and urine culture pre and post-PCNL and its impact on SIRS.
Between January 2016 and April 2018 120 patients underwent PCNL for stone disease. All patients had preoperative urine culture (PrUC), peroperative stone culture (PSC) and postoperative urine culture (PoUC) was obtained in case of postoperative fever. The operation was performed either with sterile urine culture or, if not possible and bacterial growth >100.000 CFU/mL, specific antibiotic treatment for at least 7 days prior to PCNL. The charts of patients were retrospectively reviewed for infective complications and PrUC, PoUC were compared with PSC.
Thirty-three (27.5%) patients had postoperative fever. Thirty-one (25.8%) patients required iv antibiotic regimen after PCNL. Eleven patients (9.1%) had bacterial growth on PSC and 5 (4.2%) patients had persistent bacterial growth on PrUC. PoUC was positive in 6 (5%) patients, all with fever requiring iv antibiotic regimen. Among the 11 positive PSC, 4 patients had fever postoperatively and all of them had positive PoUC. There was a 50% concondance of PSC and PoUC in these 4 patients and the grown bacteria were the same in 2 (Pseudomonas & E. coli). The remaining 7 patients with positive PSC had no fever postoperatively and all had negative PoUC. Only one patient had PSC the same as PrUC (E. coli) and no postoperative fever was observed post-PCNL. Among 33 patients with postoperative fever only 4 (12%) and 5 patients (15%) had positive stone culture and PoUC, respectively.
Concordance rate of PSC with PrUC and PoUC is low. PSC seems to be unreliable predictor of post-PCNL fever and SIRS, and seems not to have high clinical impact in this cohort of patients.
Samed Verep– Istanbul, Istanbul, Turkey
Tzevat Tefik– Associate Professor of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Istanbul, Turkey
Enes Degirmenci– Istanbul, Istanbul, Turkey
Selcuk Erdem– Academic Staff (Urologist), Department of Urology Istanbul University, Istanbul Faculty of Medicine, Fatih, Istanbul, Turkey
Taner Kocak– Istanbul, Istanbul, Turkey
Ismet Nane– Istanbul, Istanbul, Turkey
Faruk Ozcan– Istanbul, Istanbul, Turkey
Associate Professor of Urology
Istanbul University Istanbul Faculty of Medicine
Istanbul, Istanbul, Turkey
Tzevat Tefik studied Medicine at Istanbul University, Cerrahpaşa Faculty of Medicine, English Department (1997-2004) and then he finished his Urology training (2005-2011) at Istanbul University, Istanbul Faculty of Medicine. He did a short fellowship in Tenon Hospital (2015) with Professor Olivier Traxer.
Tzevat has published more than 35 peer-reviewed articles and over 140 published abstracts/presentations in National/International meetings. These cover a broad range of topics in Endourology, Renal Transplantation, Oncology, Laparoscopy and Paediatric Urology.
Academic Staff (Urologist)
Department of Urology Istanbul University, Istanbul Faculty of Medicine
Fatih, Istanbul, Turkey
Selcuk Erdem, MD, Fellow of European Board of Urology (FEBU)
Department of Urology, Istanbul University Istanbul Faculty of Medicine