Management of Infectious Complications in Percutaneous Nephrolithotomy

Abstract

Infectious complications are one of the most frequent and feared adverse medical events in percutaneous nephrolithotomy. They represent a dangerous and life-threatening condition, especially when postoperative septicemia or severe sepsis develops. In order to limit morbidity and mortality it is crucial to recognize preoperative and intraoperative risk factors that could be clear contributors to an adverse infectious event; those factors are mainly immunosuppression caused by some comorbidities, presence of urinary infection or colonization, stone characteristics, obstruction, long-lasting operation, and high intrapelvic pressure during nephrolithotomy. Close observation during the immediate and early postoperative period must be established and a high index of suspicion must be maintained to identify a major complication. The early recognition and prompt multidisciplinary management of sepsis is mandatory to optimize the final outcome. Appropriate therapy is a continuum of management of infection, ranging from adequate drainage and broad-spectrum antibiotics to aggressive fluid resuscitation and invasive monitoring with medical management in the intensive care setting until the causative agent is found and eradicated.

Comparison between tubeless mini-percutaneous nephrolithotomy versus flexible ureterorenoscopic lithotripsy for the treatment of upper ureteral calculi larger than 1 cm

“…[26] This is crucial in treating urinary calculi because most complications are related to prolonged operative time. [31] Significant shorter hospital stay is observed in tubeless fURSL group, which is also compatible with other studies. There is no significant difference in overall complication rates between the 2 groups in our study.…”

Prophylactic Antibiotic Guidelines in Modern Interventional Radiology Practice

“…102 However, in patients with struvite stone disease, urease-producing bacteria, such as Staphyloccocus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, Micrococcus luteus, and especially Proteus mirabilis may be found; it is noted that the bacteriology of the stone may not be reflected in urine culture. 103 Patients who are at high risk for infectious complications include the elderly and those who are immunosuppressed, as well as patients with diabetes, stone disease, ureterointestinal conduits, renal insufficiency or voiding dysfunction, and previously instrumented patients who are suboptimally drained. 104 The use of PR-ABX is not universally accepted in PCN.…”

Complicaciones infecciosas asociadas a la nefrolitotomía percutánea en un hospital universitario de Colombia

“…Los factores intraoperatorios asociados al desarrollo de Respuesta Inflamatoria Sistémica post NLP son la hidronefrosis, la carga litiásica, NLP previa ipsilateral, cálculos caliceales, tipo de cálculos, múltiples trayectos de acceso, tiempo quirúrgico, la cantidad de líquido de irrigación y las transfusiones postoperatorias. [5][6][7] Aunque la fiebre aislada es relativamente frecuente después del procedimiento (21%-32,1%), la incidencia de la sepsis (0,3%-4,7%) y de choque séptico (0,3-1%) es bajo. 8,9 A pesar de que la frecuencia de complicaciones infecciosas es baja, ellas implican en un sobrecosto derivado de los tiempos de hospitalización, del uso de antibióticos y las de mayor severidad, se asocian con un alto riesgo de mortalidad.…”