Comparison of renal pelvic pressure and postoperative fever incidence between standard‐ and mini‐tract percutaneous nephrolithotomy

Abstract

This study was proposed to compare the clinical effectiveness of mini-tract percutaneous nephrolithotomy (MPCNL) with standard-tract percutaneous nephrolithotomy (SPCNL) and verify whether MPCNL is associated with both higher renal pelvic pressure (RPP) and incidence of postoperative fever. A total of 228 patients with kidney stone were randomly allocated to the MPCNL group (n=114) and SPCNL group (n=114). Both intraoperative and postoperative indexes along with the incidence of complications were compared between the two treatment groups. RPP was measured using a baroreceptor which was connected to an open-ended ureteric catheter during the operation of percutaneous nephrolithotomy. The MPCNL group exhibited significantly longer average operation time, more average amount of flush water, and lesser average amount of bleeding during the operation than the SPCNL group (p<0.05). Moreover, significantly lesser average amount of postoperative serum creatinine, shorter average hospital stay, and more average amount of postoperative hemoglobin were observed in the MPCNL group than in the SPCNL group (p<0.05). MPCNL were more applicable to clear caliceal stones (p<0.05), whereas SPCNL were more effective for the removal of simple pelvic stones. The difference in the incidence of postoperative fever between the two treatment groups also appeared to be significant (p<0.05). Logistic regression provided solid evidence that both RPP and its accumulation time at which RPP≥30 mmHg significantly affected the incidence of postoperative fever. MPCNL was correlated with both higher RPP and increased likelihood of postoperative fever compared with SPCNL.

Vacuum-assisted mini-percutaneous nephrolithotomy: a new perspective in fragments clearance and intrarenal pressure control

“…To reduce the morbidity associated with this procedure, miniaturized PCNL systems were developed [3][4][5][6]. However, these systems present some limitations such as a more difficult stone fragments retrieval, a smaller visual field, longer operative times (OT) and higher intrarenal pressures (IRPs) [7,8]. In particular, IRP higher than 30 mmHg (40.78 cmH 2 O) has been proven to cause pyelovenous backflow [9], potentially leading to infectious complications [10].…”

Consultation on kidney stones, Copenhagen 2019: lithotripsy in percutaneous nephrolithotomy

“…Omar et al evaluated the impact of irrigation pressures in standard PCNL on risk of systemic inflammatory response syndrome (SIRS) and observed that high-pressure fluid irrigation was a risk factor for postoperative SIRS [35]. Chu et al focused specifically on the differences between standard and mini PCNL and found comparatively higher intrarenal pressures for mini PCNL, and also noted that mini PCNL procedures were more likely to be associated with postoperative sepsis [36]. In a porcine model, mini PCNL was associated with higher intrarenal pressures and higher risk of organ bacterial seeding in the setting of an infected collecting system, suggesting a higher potential for infectious complications [37].…”

Development of an innovative intrarenal pressure regulation system for mini-PCNL: A preliminary study

“…Duration (>60 s) of raised renal pelvic pressure >30 mmHg also predicts the chances of postoperative fever, irrespective of the tract size. [1] Guo et al . in 2008 reported that higher intrapelvic pressures >30 mmHg for >10 min is associated with higher incidence of complications during mini-PCNL.…”

“…measured the IRPs during standard (24 Fr) and mini-PCNL (18 Fr) and found that pressures >30cm of H2O were a risk factor for postoperative fever. [1] Tokas et al . found that during mini-PCNL the IRPs ranged from 10 to 45 cm of water.…”