Percutaneous Nephrolithotomy Can Reduce the Incidence of Sepsis Compared with Flexible Ureteroscopy in Treating Solitary Proximal Ureteral Stone Patients with Positive Urine Culture

Background. Sepsis is a potentially lethal complication for both flexible ureteroscopy (fURS) and percutaneous nephrolithotomy (PCNL). This study is aimed at comparing the sepsis rate after fURS and PCNL and the risk factors for sepsis in patients with solitary proximal ureteral stone. Methods. We reviewed the data of patients with calculi between 10 mm to 20 mm who underwent fURS or PCNL surgery from Tongji Hospital’s database. A total of 910 patients were eligible with 412 fURS cases and 498 PCNL cases. We used univariate analysis and multivariate logistic regression analysis to identify the risk factors for sepsis. Subgroup analysis was performed using logistic regression analysis. Results. In the cohort, 27 (6.6%) and 19 (3.8%) patients developed sepsis after fURS and PCNL, respectively. Multivariate analysis shows that the risk factors for sepsis are fURS ( OR = 3.160 , P = 0.004 ), serum WBC ≥ 10,000 cells/μL ( OR = 3.490 , P = 0.008 ), albumin − globulin ratio < 1.2 ( OR = 2.192 , P = 0.029 ), positive urine culture ( OR = 6.145 , P < 0.001 ), and prolonged operation time ( OR = 1.010 , P = 0.046 ). Subgroup analysis was conducted using potential risk factors: stone size, serum WBC, urine culture, and albumin-globulin ratio (AGR). In subgroup of positive urine culture, patients were more likely to develop sepsis after fURS than PCNL. Conclusions. PCNL may be a better choice than fURS to reduce postoperative sepsis, especially for patients with positive urine culture.

The runaway kidney: a rare case of a parastomal hernia with partial kidney herniation

Although parastomal hernias are a common complication of ostomy formation, herniation of intra-abdominal organs, aside from intestine, is infrequent. Furthermore, herniation of retroperitoneal organs, such as the kidney, is an extremely rare finding. We report the case of a 59-year-old male with a right ileostomy who presented with an acute kidney injury with suggestive urinary tract infection. A computed tomography scan revealed a left proximal ureteral stone with left hydronephrosis and a prominent right parastomal hernia with herniation of the mesenteric/retroperitoneal fat, portion of the right kidney, right proximal ureter and some bowel. The patient was taken to the operating room for a left cystourethroscopy with stent placement and made a full recovery. Due to the patient’s extensive surgical history, high risk of postoperative infection and lack of evidence demonstrating functional impairment of the right kidney, surgical intervention was not recommended at the present time.