Percutaneous Nephrolithotomy in Patients with Incidental Encountered Purulent Urine at Initial Puncture

Abstract

Objective: We are reporting the 39 patients’ outcomes who underwent percutaneous nephrolithotomy and purulent urine is encountered at the initial steps of surgery. Method: Of 873 patients who underwent PCNL, 48 had purulent fluid during the initial puncture. After excluding those at risk for infection, we studied 39 patients' preoperative and postoperative variables - including postoperative day (POD) 1,3,5 fevers. In group 1, 21 patients had a nephrostomy tube placed, and PCNL was postponed. In group 2, 18 patients had successful stone removal in the first session. Results: All surgeries were successful, with no septic events during follow-up. No significant differences in preoperative variables were found. 14% and 22% of patients in groups 1 and 2 had infected fluid (p= 0.470). Four patients in group 1 (19 %) and seven patients in group 2 (38.9 %) had a high fever (≥ 38 C) on POD1 (p =0.171), and 1 (5%) in group 1 and 3 (17%) in group 2 had high fever on POD 3 (p= 0.22). No patients remained with high fever on POD5. Mild sepsis was diagnosed in 9.5 % of group 1 and 16 % of group 2 (p= 0,820), and hospitalization time differed significantly (p< 0.001). Stone size and operation time were correlated with postoperative fever, and prolonged hospital stays were correlated with positive blood cultures and postponed procedures. Conclusion: PCNL with proper technique and antibiotics can lead to quicker recovery and reduced hospitalization in selected patients with pus in their urine during surgery