scholarly journals The Evaluation of Risk Factors for Postoperative Infectious Complications after Percutaneous Nephrolithotomy

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Tian Yang ◽  
Shenghua Liu ◽  
Jimeng Hu ◽  
Lujia Wang ◽  
Haowen Jiang
Keyword(s):  
Risk Factors ◽  
Serum Albumin ◽  
Percutaneous Nephrolithotomy ◽  
Protective Factor ◽  
Clinical Information ◽  
Renal Stones ◽  
Infectious Complications ◽  
Stone Size ◽  
Postoperative Fever ◽  
Detailed Clinical Information

This study was to evaluate the risk factors of infectious complications after percutaneous nephrolithotomy (PCNL) and build a prediction tool for postoperative complications based on the risk factors. A total of 110 male (67.1%) and 54 female (32.9%) patients who underwent PCNL for renal stones between 2010 and 2014 in our institute were included. A detailed clinical information and laboratory results were obtained from patients. Systemic inflammatory response syndrome (SIRS) and postoperative fever were recorded after PCNL surgery. In all, 45 cases (27.4%) developed SIRS and fever was observed in 20 cases (12.2%). In multivariate analysis, stone size (odds ratio, OR = 1.471,p=0.009) and urine white blood cell (WBC) (OR = 1.001,p=0.007) were related to the development of SIRS. Stone size (OR = 1.644,p=0.024), urine WBC (OR = 1.001,p=0.002) and serum albumin (OR = 0.807,p=0.021) were associated with postoperative fever. We concluded that patients with larger stone size and preoperative urinary tract infection might have a higher risk of developing SIRS and fever after operation, while a high-normal level of serum albumin might be the protective factor for postoperative fever.

scholarly journals Postoperative fever after liver resection: Incidence, risk factors, and characteristics associated with febrile infectious complication

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262113
Author(s):  
Hon-Fan Lai ◽  
Ivy Yenwen Chau ◽  
Hao-Jan Lei ◽  
Shu-Cheng Chou ◽  
Cheng-Yuan Hsia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Liver Resection ◽  
Serum Albumin ◽  
Predictive Value ◽  
Infectious Complication ◽  
Infectious Complications ◽  
Low Grade ◽  
Postoperative Fever ◽  
Grade Iii

Purpose To evaluate the incidence and risk factors of postoperative fever (POF) after liver resection. In patients with POF, predictors of febrile infectious complications were determined. Methods A total of 797 consecutive patients undergoing liver resection from January 2015 to December 2019 were retrospectively investigated. POF was defined as body temperature ≥ 38.0°C in the postoperative period. POF was characterized by time of first fever, the highest temperature, and frequency of fever. The Institut Mutualiste Montsouris (IMM) classification was used to stratify surgical difficulty, from grade I (low), grade II (intermediate) to grade III (high). Postoperative leukocytosis was defined as a 70% increase of white blood cell count from the preoperative value. Multivariate analysis was performed to identify risk factors for POF and predictors of febrile infectious complications. Results Overall, 401 patients (50.3%) developed POF. Of these, 10.5% had the time of first fever > postoperative day (POD) 2, 25.9% had fever > 38.6°C, and 60.6% had multiple fever spikes. In multivariate analysis, risk factors for POF were: IMM grade III resection (OR 1.572, p = 0.008), Charlson Comorbidity Index score > 3 (OR 1.872, p < 0.001), and serum albumin < 3.2 g/dL (OR 3.236, p = 0.023). 14.6% patients developed infectious complication, 21.9% of febrile patients and 7.1% of afebrile patients (p < 0.001). Predictors of febrile infectious complications were: fever > 38.6°C (OR 2.242, p = 0.003), time of first fever > POD2 (OR 6.002, p < 0.001), and multiple fever spikes (OR 2.039, p = 0.019). Sensitivity, specificity, positive predictive value and negative predictive value for fever > 38.6°C were 39.8%, 78.0%, 33.7% and 82.2%, respectively. A combination of fever > 38.6°C and leukocytosis provided high specificity of 95.2%. Conclusion In this study, we found that IMM classification, CCI score, and serum albumin level related with POF development in patients undergone liver resection. Time of first fever > POD2, fever > 38.6°C, and multiple fever spikes indicate an increased risk of febrile infectious complication. These findings may aid decision-making in patients with POF who require further diagnostic workup.

scholarly journals Safety and efficacy of Chinese minimally invasive percutaneous nephrolithotomy in the management of renal stones ≤ 2 cm: a single-center experience

2019 ◽  
Vol 25 (1) ◽  
Author(s):  
Elsayed M. Salih ◽  
Ibrahim Elsotohi ◽  
Hisham Elhelaly ◽  
Mohamed Elsalhy ◽  
Mourad M. Mourad
Keyword(s):  
Minimally Invasive ◽  
Percutaneous Nephrolithotomy ◽  
Renal Stone ◽  
Renal Stones ◽  
Stone Size ◽  
Intraoperative Complication ◽  
Safety And Efficacy ◽  
Single Center Experience ◽  
Minimally Invasive Percutaneous Nephrolithotomy ◽  
The Mean

Abstract Background The goal for using smaller caliber instruments in PNL was to reduce the access-related complications and to decrease morbidity. The objective of this study was to evaluate the safety and efficacy of Chinese minimally invasive percutaneous nephrolithotomy (MIPNL) in the treatment of renal stones ≤ 20 mm. Results Sixty-seven patients completed the study protocol. The mean age was 41.10 ± 13.99 years (range 18–68 years). There were 43 (64%) male and 24 (36%) females. The mean stone size was ranged from 78.5 to 439.6 mm2 (mean ± SD 172.48 ± 69.54 mm2). The overall SFR was (82%). Twelve (18%) needed post-MIPNL auxiliary procedure, in the form of second MIPNL in 3 (4.5%) cases, SWL in 7 (10%), and RIRS in 2 (3%) cases. The intraoperative complication was present in four patients (5%) include bleeding necessitate blood transfusion in one patient (1.5%) and renal collecting system perforation 3 (4.5%). The postoperative complication was urine leakage 5 (7.5) and fever in 6 (9%) of patients. Conclusion Chinese MIPNL is safe and effective method for treatment of renal stone ≤ 20 mm size with satisfactory SFR and low complication rate when SWL failed or contraindicated. It is considered a feasible treatment alternative to standard PNL, in the absence of flexible URS or miniature nephroscope.

scholarly journals Variation of Fluoroscopic Radiation Dose during Endourological Procedures for Renal Stones

2020 ◽  
Vol 3 (1) ◽  
pp. 272-275
Author(s):  
Prakash Chhettri ◽  
Robin Bahadur Basnet ◽  
Anil Shrestha ◽  
Parash Mani Shrestha
Keyword(s):  
Radiation Dose ◽  
Percutaneous Nephrolithotomy ◽  
Prospective Observational Study ◽  
Renal Stones ◽  
Retrograde Intrarenal Surgery ◽  
Stone Size ◽  
Ureteral Access Sheath ◽  
Pelvicalyceal System ◽  
Ureteric Catheter ◽  
Fluoroscopic Time

Introduction: Fluoroscopic guidance is routine for endourological procedures like percutaneous nephrolithotomy and retrograde intrarenal surgery in vast majority of centers. It is used for the initial retrograde ureteral access to define the pelvicalyceal system, puncture of the desired calyx and dilatation of the tract, aid navigation of stones and calyces, and placement of guide wires and stents. Both the patient and operating staffs are exposed to the radiation during surgery. The purpose of this study is to measure that exposed fluoroscopic radiation dose during these procedures and make operating surgeons aware of their fluoroscopic habit. Materials and Methods: This is prospective observational study, who underwent percutaneous nephrolithotomy (n=60) and retrograde intrarenal surgery (n=43) in our institute between December 2017 and August 2018. Percutaneous nephrolithotomy was done in prone position with prior insertion of ureteric catheter. Retrograde intrarenal surgery was carried out with or without insertion of ureteral access sheath. Fluoroscopic time was taken from the insertion of the ureteric catheter or UAS to the completion of the procedure with double J stenting. Results: For percutaneous nephrolithotomy and retrograde intrarenal surgery group, mean stone size were 21.89 mm and 10.56 mm; mean fluoroscopic time were 117.95 s (range 24-350) and 31.83 s (range 3-103); mean fluoroscopic dose were 29.71 mGy and 6.19 mGy respectively. Introduction: Fluoroscopic guidance is routine for endourological procedures like percutaneous nephrolithotomy and retrograde intrarenal surgery in vast majority of centers. It is used for the initial retrograde ureteral access to define the pelvicalyceal system, puncture of the desired calyx and dilatation of the tract, aid navigation of stones and calyces, and placement of guide wires and stents. Both the patient and operating staffs are exposed to the radiation during surgery. The purpose of this study is to measure that exposed fluoroscopic radiation dose during these procedures and make operating surgeons aware of their fluoroscopic habit. Materials and Methods: This is prospective observational study, who underwent percutaneous nephrolithotomy (n=60) and retrograde intrarenal surgery (n=43) in our institute between December 2017 and August 2018. Percutaneous nephrolithotomy was done in prone position with prior insertion of ureteric catheter. Retrograde intrarenal surgery was carried out with or without insertion of ureteral access sheath. Fluoroscopic time was taken from the insertion of the ureteric catheter or UAS to the completion of the procedure with double J stenting. Results: For percutaneous nephrolithotomy and retrograde intrarenal surgery group, mean stone size were 21.89 mm and 10.56 mm; mean fluoroscopic time were 117.95 s (range 24-350) and 31.83 s (range 3-103); mean fluoroscopic dose were 29.71 mGy and 6.19 mGy respectively. Conclusions: Among the endourological procedures for renal stones, retrograde intrarenal surgery was associated with less fluoroscopic hazard than percutaneous nephrolithotomy. Awareness of fluoroscopic exposure duration and experience of a surgeon can minimize the radiation hazard during endourological procedures.

scholarly journals Risk factors of infectious complications after retrograde intrarenal surgery: a retrospective clinical analysis

2020 ◽  
Vol 48 (9) ◽  
pp. 030006052095683
Author(s):  
Hua Zhang ◽  
Tao Jiang ◽  
Rui Gao ◽  
Qin Chen ◽  
Weiwen Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Operative Time ◽  
Small Diameter ◽  
Modern Society ◽  
Clinical Analysis ◽  
Infectious Complications ◽  
Stone Disease ◽  
Lithotomy Position ◽  
Retrograde Intrarenal Surgery ◽  
Stone Size

Objective Stone disease is one of the most common afflictions in modern society. Complications following retrograde intrarenal surgery (RIRS) vary considerably, and small-diameter ureteral access sheaths are reportedly significantly associated with rates of infectious complications following RIRS. This study aimed to explore additional risk factors for infectious complications after RIRS. Methods This study retrospectively analyzed 602 patients who underwent RIRS between December 2016 and October 2019 at the First Affiliated Hospital of Fujian Medical University. All flexible ureteroscopic lithotripsy processes were conducted with patients under general anesthesia in the low lithotomy position. Postoperative systemic inflammatory response syndrome (SIRS) was diagnosed; statistical analyses comprised two-way analysis of variance (ANOVA) and one-way multivariate ANOVA. Results The incidence of infectious complications after RIRS was 7.14%. Operative time was an independent risk factor that increased the risk of infection. Stone size >2 cm was observed in 153 (27.37%) patients in the SIRS group and 29 patients (67.44%) in the non-SIRS group. Conclusions Findings in the literature suggest that early antibiotic treatment and active fluid therapy might lower the rate of infectious complications after RIRS. Our results indicate that extended operative time and increased stone size may be risk factors for infectious complications after RIRS.

scholarly journals Establishment of a Predictive Model for Factors Related to Systemic  Inflammatory Response Syndrome (SIRS) after Percutaneous Nephrolithotomy (PCNL)

2020 ◽  
Author(s):  
Min Ju ◽  
Jin Zheng ◽  
Lin Lin Gao ◽  
Li Ying Pan
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Predictive Model ◽  
Percutaneous Nephrolithotomy ◽  
Operative Time ◽  
Univariate Analysis ◽  
Renal Stones ◽  
Systemic Inflammatory Response

Abstract Background: Percutaneous nephrolithotomy (PCNL) is a primary treatment method for renal stones, but infection is a very common postoperative complication. Systemic inflammatory response syndrome (SIRS) is a stage of the infection process and a very important early clinical manifestation of sepsis, so identifying the risk factors associated with SIRS after PCNL is important for ensuring patient safety and preventing sepsis.Objective: To analyze the risk factors for SIRS after PCNL, identify the predictive factors, and perform risk factor analysis.Methodology: Between September 2016 and September 2017, 352 patients who were diagnosed with renal stones and treated with PCNL were included in this study. The patients were divided into two groups according to whether SIRS occurred. Univariate analysis was performed on the related risk factors, including patient age; gender; body mass index; urine culture; number, types and quantity of rental stones; diabetes; blood glucose; complications; hospital stay; residual stones; and Guy’s degree. Then, logistic regression was used to perform multivariate analysis and establish a predictive model.Results: A total of 352 patients with renal stones were treated with PCNL, and 106 patients (30.1%) developed SIRS after surgery. Operative time, preoperative fever and diabetes were found to be risk factors, and the logistic regression results indicated that diabetes (OR=2.049, 95%CI 1.008~4.166) and operative time (OR=1.011, 95%CI 1.003~1.019) could be entered into the regression equation. Therefore, the predictive regression model was P=1/[1+e-(-2.097+0.712 diabetes + 0.012 operative time)].Conclusion: Diabetes and operative time are independent risk factors for SIRS after PCNL, so the probability of SIRS after PCNL can be determined according to these two indicators.

Risk Factors for Urinary Lithotripsy-Associated Sepsis

1993 ◽  
Vol 14 (8) ◽  
pp. 469-472 ◽  
Author(s):  
Robert Orenstein ◽  
James E. Bross ◽  
Mary Dahlmann
Keyword(s):  
Risk Factors ◽  
Infectious Complications ◽  
Control Groups ◽  
Retrospective Case ◽  
Stone Size ◽  
Extracorporeal Shock Wave ◽  
Tract Infections ◽  
Regional Referral Center ◽  
Control Study

AbstractObjectives:To identify risk factors for sepsis following urinary extracorporeal shock wave lithotripsy (ESWL).Design:Retrospective case-control study with two control groups.Setting:A rural, 570-bed, regional referral center.Results:Six cases (four bacteremias and two fungemias) were compared with two sets of 18 controls. Cases had a higher frequency and number of urinary tract infections prior to the procedure and tended to have larger stone size.Conclusions:Patients undergoing ESWL who are at high risk for infectious complications may be identified by preprocedure evaluation. Such patients may require alternative prophylactic regimens and close postprocedure follow-up.

scholarly journals Effectiveness and Safety of Percutaneous Nephrolithotomy (PCNL) in Malrotated Kidneys

2021 ◽  
Vol 15 (8) ◽  
pp. 2362-2365
Author(s):  
Sami ur Rehman ◽  
Liaqat Ali ◽  
Jehanzeb . ◽  
Muhammad Asif ◽  
Syed Arif ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Surgical Technique ◽  
Percutaneous Nephrolithotomy ◽  
Preoperative Evaluation ◽  
Renal Stones ◽  
Stone Size ◽  
Stone Clearance ◽  
Large Size ◽  
Group I ◽  
Staghorn Stone

Background and Aim: The renal stones of any size could be effectively managed through an essential surgical technique known as Percutaneous Nephrolithotomy (PCNL). The large size renal stones with abnormal kidneys imposed additional challenges for PNCL in anomalous kidneys. The present study aimed to evaluate the effectiveness and safety of Percutaneous Nephrolithotomy in malrotated kidneys. Place and Duration: Conducted at Urology department of Mian Gul Abdulhaq Jehanzeb Kidney Hospital Manglawar, Swat for duration of two years (from May 2019 to April 2021). Materials and Methods. This single-centered retrospective study was conducted on 80 patients who underwent percutaneous nephrolithotomy with malrotation kidneys. The individuals with anomalous kidneys and complex calculi were enrolled in this study. These patients had kidneys anomalies such as horseshoe kidneys, crossed fused ectopia, malrotation kidneys, pelvic and complete stone clearance. Posterior or anterior approaches were followed for the procedure after preoperative evaluation in kidney anomalies. Retrograde catheterization was carried out under spinal and general anesthesia with the patients. For all the patients, stone size and clearance were measured. Results: Of the total 80 kidneys anomalies patients, 55 (68.7%) were male and 25 (31.3%) were females. Overall mean age was 35.26 ± 13.51. The stone size varied from 1.3cm to 7 cm. Patients were categorized into two groups based on stone sizes such as group I (1.3-2.5 cm) had 42 (52.5%) and group II (25-7cm) 38 (47.5%) patients. The patients included renal pelvis 19 (23.6%), the pelvic ureteric junction (PUJ) 8 (10%), horseshoe kidneys 2 (2.5%), crossed fused ectopia 9 (11.3%), and malrotation kidneys 3 (3.8%).The stone clearance was completed in 77 (96.3%) patients. The statistically significant factor for complete clearance was the staghorn stone calculus. Conclusion: Percutaneous nephrolithotomy is a safe and effective procedure for large renal stones management in patients of anomalous kidneys. Higher renal stones clearance can be achieved with minimum morbidity by suitable preoperative evaluation and technical experts. Keywords: Malrotated kidney; Nephrostomy, Percutaneous; Nephrolithiasis; Abnormality

Number of Tracts or Stone Size: Which Influences Outcome of Percutaneous Nephrolithotomy for Staghorn Renal Stones?

2012 ◽  
Vol 89 (1) ◽  
pp. 103-106 ◽  
Author(s):  
Robab Maghsoudi ◽  
Masoud Etemadian ◽  
Pejman Shadpour ◽  
Mohammad Hadi Radfar ◽  
Hadi Ghasemi ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Renal Stones ◽  
Stone Size
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