Clinical effectiveness of percutaneous nephrolithotomy (PCNL) in patients who initially presented with urosepsis_Chinese Journal of Evidence-Based Medicine

Authors：

YANG Minggen , ZHENG Zhouda , XU Zhenqiang , ZHANG Chaoxian , LIN Haili , ZHUANG Zhiming ,  ZHENG Yishu

Department of Urology, Zhangzhou Affiliated Hospital, Fujian Medical University, Zhangzhou, 363000, P.R.China;

Corresponding author：

ZHENG Yishu, Email: 597281365@qq.com

Keywords：

Percutaneous nephrolithotomy; Urosepsis; Urolithiasis; Matched-pair analysis

DOI：

10.7507/1672-2531.201605035

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Objective To compare clinical outcomes of percutaneous nephrolithotomy (PCNL) in patients who initially presented with and without urosepsis. Methods The study included patients who underwent PCNL for renal and ureter urolithiasis removal from January 2010 to December 2014 in our hospital. A 1∶1 matched-pair analysis was performed to compare outcomes and complications of patients who had obstructive urolithiasis with urosepsis initially (OUU) with patients who had obstructive urolithiasis with no urosepsis initially (NOUU) before PCNL. Results A total of 172 patients were included involving 122 (71%) males and 50 (29%) females with a mean age of 46.2 years (range 32 to 65 years). There were no significant differences between two groups in age, gender, BMI, complications, the size of the stones, stone's number and stone location (P>0.05). OUU groups had the similar stone-free rates (86.0%vs. 84.8%, P=0.829) as the NOUU group. OUU group had higher overall complications rate, longer duration of nephrostomy tube (NT), longer hospital length of stay (LOS), longer courses of postoperative antibiotics and higher grade of antibiotics after PCNL (all P<0.05). Higher fever developed postoperatively (11.6%vs. 3.5%, P=0.043), higher asymptomatic bacteriuria (11.6% vs. 3.5%, P=0.043) and symptomatic urinary tract infections (10.5% vs. 2.3%, P=0.029) were also found in OUU groups. There was no significant difference between two groups in sepsis (2.3% vs. 1.2%, P=0.560). Conclusion PCNL after decompression for urolithiasis-related urosepsis has similar success but higher complication rates than obstructive urolithiasis with no urosepsis initially.

Citation： YANG Minggen, ZHENG Zhouda, XU Zhenqiang, ZHANG Chaoxian, LIN Haili, ZHUANG Zhiming, ZHENG Yishu. Clinical effectiveness of percutaneous nephrolithotomy (PCNL) in patients who initially presented with urosepsis. Chinese Journal of Evidence-Based Medicine, 2017, 17(10): 1135-1139. doi: 10.7507/1672-2531.201605035 Copy

1.	Wagenlehner FM, Lichtenstern C, Rolfes C, et al. Diagnosis and management for urosepsis. Int J Urol, 2013, 20(10): 963-970.
2.	Wagenlehner FM, Weidner W, Naber KG. Optimal management of urosepsis from the urological perspective. Int J Antimicrob Agents, 2007, 30(5): 390-397.
3.	Levy MM, Artigas A, Phillips GS, et al. Outcomes of the surviving sepsis campaign in intensive care units in the USA and Europe: a prospective cohort study. Lancet Infect Dis, 2012, 12(12): 919-924.
4.	Wagenlehner FM, Pilatz A, Weidner W. Urosepsis-from the view of the urologist. Int J Antimicrob Agents, 2011, 38(suppl): 51-57.
5.	Goldsmith ZG, Oredein-McCoy O, Gerber L, et al. Emergent ureteric stent vs. percutaneous nephrostomy for obstructive urolithiasis with sepsis: patterns of use and outcomes from a 15-year experience. BJU Int, 2013, 112(2): 122-128.
6.	Uppot RN. Emergent nephrostomy tube placement for acute urinary obstruction. Tech Vasc Interv Radiol, 2009, 12(2): 154-161.
7.	Preminger GM, Tiselius HG, Assimos DG, et al. 2007 Guideline for the management of ureteral calculi. Eur Urol, 2007, 52(6): 1610-1631.
8.	Morris DS, Wei JT, Taub DA, et al. Temporal trends in the use of percutaneous nephrolithotomy. J Urol, 2006, 175(5): 1731-1736.
9.	Michel MS, Trojan L, Rassweiler JJ. Complications in percutaneous nephrolithotomy. Eur Urol, 2007, 51(4): 899-906.
10.	Skolarikos A, Alivizatos G, de la Rosette JJ. Percutaneous nephrolithotomy and its legacy. Eur Urol, 2005, 47(1): 22-28.
11.	Osman M, Wendt-Nordahl G, Heger K, et al. Percutaneous nephrolithotomy with ultrasonography-guided renal access: experience from over 300 cases. BJU Int, 2005, 96(6): 875-878.
12.	ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med, 1992, 20(6): 864-874.
13.	Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
14.	Bartoletti R, Cai T, Mondaini N, et al. Epidemiology and risk factors in urolithiasis. Urol Int, 2007, 79(Suppl 1): 3-7.
15.	Alivizatos G, Skolarikos A. Is there still a role for open surgery in the management of renal stones? Curr Opin Urol, 2006, 16(2): 106-111.
16.	Samplaski MK, Irwin BH, Desai M. Less-invasive ways to remove stones from the kidneys and ureters. Cleve Clin J Med, 2009, 76(10): 592-598.
17.	Fernstrom I, Johansson B. Percutaneous pyelolithotomy. a new extraction technique. Scand J Urol Nephrol, 1976, 10(3): 257-259.
18.	Basiri A, Tabibi A, Nouralizadeh A, et al. Comparison of safety and efficacy of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy in patients with renal pelvic stones: a randomized clinical trial. Urol J, 2014, 11(6): 1932-1937.
19.	Srisubat A, Potisat S, Lojanapiwat B, et al. Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database Syst Rev, 2014, 24(11): CD007044.
20.	de la Rosette J, Assimos D, Desai M, et al. The clinical research office of the endourological society percutaneous nephrolithotomy global study: indications, complications, and outcomes in 5 803 patients. J Endourol, 2011, 25(1): 11-17.
21.	De S, Autorino R, Kim FJ, et al. Percutaneous nephrolithotomy versus retrograde intrarenal surgery: a systematic review and meta-analysis. Eur Urol, 2015, 67(1): 125-137.
22.	Seitz C, Desai M, Hacker A, et al. Incidence, prevention, and management of complications following percutaneous nephrolitholapaxy. Eur Urol, 2012, 61(1):146-158.
23.	Labate G, Modi P, Timoney A, et al The percutaneous nephrolithotomy global study: classification of complications. J Endourol, 2011, 25(8): 1275-1280.
24.	Gutierrez J, Smith A, Geavlete P, et al. Urinary tract infections and post-operative fever in percutaneous nephrolithotomy. World J Urol, 2013, 31(5): 1135-1140.
25.	Grabe M. Controversies in antibiotic prophylaxis in urology. Int J Antimicrob Agents, 2004, 23(Suppl 1): 17-23.
26.	Serniak PS, Denisov VK, Guba GB, et al. The diagnosis of urosepsis. Urol Nefrol, 1990, 6(4): 9-13.
27.	Brun-Buisson C. The epidemiology of the systemic inflammatory response. Intensive Care Med, 2000, 26(Suppl 1): 564-574.
28.	Grabe M, Bjerklund-Johensen TE, Botto H, et al. Guidelines on Urological Infections. Barcelona: The 25th EAU Annual Congress, 2010.
29.	Wolf JS Jr, Bennett CJ, Dmochowski RR, et al. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol, 2008, 179(4): 1379-1390.
30.	Bootsma AM, Laguna Pes MP, Geerlings SE, et al. Antibiotic prophylaxis in urologic procedures: A systematic review. Eur Urol, 2008, 54(6): 1270-1286.

1. Wagenlehner FM, Lichtenstern C, Rolfes C, et al. Diagnosis and management for urosepsis. Int J Urol, 2013, 20(10): 963-970.
2. Wagenlehner FM, Weidner W, Naber KG. Optimal management of urosepsis from the urological perspective. Int J Antimicrob Agents, 2007, 30(5): 390-397.
3. Levy MM, Artigas A, Phillips GS, et al. Outcomes of the surviving sepsis campaign in intensive care units in the USA and Europe: a prospective cohort study. Lancet Infect Dis, 2012, 12(12): 919-924.
4. Wagenlehner FM, Pilatz A, Weidner W. Urosepsis-from the view of the urologist. Int J Antimicrob Agents, 2011, 38(suppl): 51-57.
5. Goldsmith ZG, Oredein-McCoy O, Gerber L, et al. Emergent ureteric stent vs. percutaneous nephrostomy for obstructive urolithiasis with sepsis: patterns of use and outcomes from a 15-year experience. BJU Int, 2013, 112(2): 122-128.
6. Uppot RN. Emergent nephrostomy tube placement for acute urinary obstruction. Tech Vasc Interv Radiol, 2009, 12(2): 154-161.
7. Preminger GM, Tiselius HG, Assimos DG, et al. 2007 Guideline for the management of ureteral calculi. Eur Urol, 2007, 52(6): 1610-1631.
8. Morris DS, Wei JT, Taub DA, et al. Temporal trends in the use of percutaneous nephrolithotomy. J Urol, 2006, 175(5): 1731-1736.
9. Michel MS, Trojan L, Rassweiler JJ. Complications in percutaneous nephrolithotomy. Eur Urol, 2007, 51(4): 899-906.
10. Skolarikos A, Alivizatos G, de la Rosette JJ. Percutaneous nephrolithotomy and its legacy. Eur Urol, 2005, 47(1): 22-28.
11. Osman M, Wendt-Nordahl G, Heger K, et al. Percutaneous nephrolithotomy with ultrasonography-guided renal access: experience from over 300 cases. BJU Int, 2005, 96(6): 875-878.
12. ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med, 1992, 20(6): 864-874.
13. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
14. Bartoletti R, Cai T, Mondaini N, et al. Epidemiology and risk factors in urolithiasis. Urol Int, 2007, 79(Suppl 1): 3-7.
15. Alivizatos G, Skolarikos A. Is there still a role for open surgery in the management of renal stones? Curr Opin Urol, 2006, 16(2): 106-111.
16. Samplaski MK, Irwin BH, Desai M. Less-invasive ways to remove stones from the kidneys and ureters. Cleve Clin J Med, 2009, 76(10): 592-598.
17. Fernstrom I, Johansson B. Percutaneous pyelolithotomy. a new extraction technique. Scand J Urol Nephrol, 1976, 10(3): 257-259.
18. Basiri A, Tabibi A, Nouralizadeh A, et al. Comparison of safety and efficacy of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy in patients with renal pelvic stones: a randomized clinical trial. Urol J, 2014, 11(6): 1932-1937.
19. Srisubat A, Potisat S, Lojanapiwat B, et al. Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database Syst Rev, 2014, 24(11): CD007044.
20. de la Rosette J, Assimos D, Desai M, et al. The clinical research office of the endourological society percutaneous nephrolithotomy global study: indications, complications, and outcomes in 5 803 patients. J Endourol, 2011, 25(1): 11-17.
21. De S, Autorino R, Kim FJ, et al. Percutaneous nephrolithotomy versus retrograde intrarenal surgery: a systematic review and meta-analysis. Eur Urol, 2015, 67(1): 125-137.
22. Seitz C, Desai M, Hacker A, et al. Incidence, prevention, and management of complications following percutaneous nephrolitholapaxy. Eur Urol, 2012, 61(1):146-158.
23. Labate G, Modi P, Timoney A, et al The percutaneous nephrolithotomy global study: classification of complications. J Endourol, 2011, 25(8): 1275-1280.
24. Gutierrez J, Smith A, Geavlete P, et al. Urinary tract infections and post-operative fever in percutaneous nephrolithotomy. World J Urol, 2013, 31(5): 1135-1140.
25. Grabe M. Controversies in antibiotic prophylaxis in urology. Int J Antimicrob Agents, 2004, 23(Suppl 1): 17-23.
26. Serniak PS, Denisov VK, Guba GB, et al. The diagnosis of urosepsis. Urol Nefrol, 1990, 6(4): 9-13.
27. Brun-Buisson C. The epidemiology of the systemic inflammatory response. Intensive Care Med, 2000, 26(Suppl 1): 564-574.
28. Grabe M, Bjerklund-Johensen TE, Botto H, et al. Guidelines on Urological Infections. Barcelona: The 25th EAU Annual Congress, 2010.
29. Wolf JS Jr, Bennett CJ, Dmochowski RR, et al. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol, 2008, 179(4): 1379-1390.
30. Bootsma AM, Laguna Pes MP, Geerlings SE, et al. Antibiotic prophylaxis in urologic procedures: A systematic review. Eur Urol, 2008, 54(6): 1270-1286.

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