Category: Clinical Stones: PCNL
Introduction & Objective :
Details regarding infections that had occurred and been treated before undergoing PCNL were added to the BAUS PCNL database in 2014. We aimed to analyse these data to assess the implications that pre-operative infection would have on the outcome of PCNL, including the risk of post-operative complications, particularly of sepsis.
2630 patients between 2014 and 2016 were analysed and categorised into four groups:
i) patients who had received oral antibiotics (30.7% of total cohort)
ii) patients admitted for iv antibiotics (6.9%)
iii) patients who had required emergency drainage (either by JJ stent or nephrostomy, 8.3%)
iv) patients who had required an ITU admission for sepsis (1.7%).
Statistical differences between patients with and without prior infections were performed using Chi squared analysis.
There was no difference in the rate of abandoning the case (4.0% vs 4.6% with prior infection, p=0.46) or in the transfusion rate (1.5% vs 2.4% with previous infection, P=0.09). The overall intra-operative complication rate was also equivalent (3.3% vs 2.7% with previous infection, p=0.40), although patients with a prior ITU stay had the highest intra-operative complication rate (7.1%).
However, stone free rates were lower in infected patients (72.3% vs 83.2% (P<0.001) and post operative complications were higher (18.7% vs 11.7%); patients with previous ITU admission had the highest post-operative complication rate (30.2%). In particular, the risk of post operative fever and sepsis was seen in 6.8% and 1.4% respectively in patients with no pre-operative infection, but in 12.4% and 3.7% in any patient with prior treatment of UTI (p<0.001). Again, the risk was greatest in those with prior ITU admission, with a 14% fever rate and 11.6% sepsis rate.
Any pre-PCNL treatment for infection carries an increased risk of post operative complication, particularly of fever and sepsis, with the highest risk seen in patients who have had a prior ITU admission for Sepsis. Interestingly, the post operative stone clearance rates were also lower in patients with previous treatment for infection. These data are useful for patient counselling and suggest the need for increased vigilance for post-operative management of patients who have previously had infection, particularly those admitted to ITU for Sepsis.
Daron Smith– Consultant Urological Surgeon, Stone and Endourology Unit, Institute of Urology, University College London Hospitals NHS Foundation Trust, London, England, United Kingdom
Sarah Fowler– , London, England, United Kingdom
John Withington– Urology Registrar, Royal Free Hospital NHS Trust, London, England, United Kingdom
Jim Armitage– , Cambridge, England, United Kingdom
Stuart Irving– Norfolk and Norwich University Hospitals, Norwich, England, United Kingdom
Ben Turney– Bernard Senior Clinical Researcher in Urology, Nuffield Department of Surgical Sciences, Oxford, England, United Kingdom
Neil Burgess– , Norwich, England, United Kingdom
Oliver Wiseman– Urologist, Cambridge University Hospitals, Urology, Cambridge, United Kingdom, CAMBRIDGE, England, United Kingdom
William Finch– Consultant Urological Surgeon, Norfolk and Norwich University Hospitals, Norwich, England, United Kingdom
Consultant Urological Surgeon
Stone and Endourology Unit, Institute of Urology, University College London Hospitals NHS Foundation Trust
London, England, United Kingdom
Daron Smith is a consultant urological surgeon at the Institute of Urology at University College Hospital. His practice is "endoluminal endourology" and encompasses the comprehensive management of Urinary Tract Stone disease, and includes the endourological management of ureteric obstruction, ureteric injuries, and the endoscopic diagnosis and management of upper tract TCC. He is the vice-chairman of the BAUS Section of Endourology, having been its Secretary from 2015-17 and a committee member since 2013, is the Consulting Editor on stone disease for the BJUI and the deputy editor of the Journal of Endoluminal Endourology
Royal Free Hospital NHS Trust
London, England, United Kingdom
Bernard Senior Clinical Researcher in Urology
Nuffield Department of Surgical Sciences
Oxford, England, United Kingdom
Cambridge University Hospitals, Urology, Cambridge, United Kingdom
CAMBRIDGE, England, United Kingdom
Oliver is a Consultant Urologist based at Cambridge University Teaching Hospitaks NHS Trust Cambridge, UK. He specialises in the treatment of kidney stones, their metabolic management and in the devlopment of patient reported outcomes for stone disease. He runs a number of training courses teaching stone surgery, and has been invited to operate and lecture nationally and internationally on stone disease.
He qualified in Cambridge and following basic surgical training, he underwent specialist training in urology in London, including at Guys Hospital and UCLH ("The Institute of Urology"). He has published widely including articles relating to the management of patients with renal stone disease.
He is a trustee of BAUS, honorary treasurer elect of BAUS, a member of the BAUS Section of Endourology Committee, and on the Endourological Society Awards and Medals Committee. He is training program director for Urology for the East of England.