EAU 2018: PCNL SIRS Risk Increasing in Patients with Positive Stone Culture and Sub-optimal Renal Drainage

Copenhagen, Denmark (UroToday.com) Dr. S Bolomytis presented data that determined which preoperative risk factors and postoperative outcomes were associated with PCNL SIRS. As an introduction to his talk, Dr. Bolomytis stated the gold standard for the treatment and management of large renal stones is percutaneous nephrolithotomy. However, one of the most complications related to this procedure is systemic inflammatory response syndrome (SIRS).

For this study, Dr. Bolomystis analyzed a total 348 PCNL patients at their institution over a period of 5 years from 2011 to 2016. Once patients who developed SIRS were identified from this group, preoperative and postoperative risk factors were compared between PCNL patients who did and did not develop SIRS. These included the number of tracks during PCNL, antegrade stent post-PCNL, Positive stone culture, main stone composition, mean stone composition s%, and post-op imaging for residual stones.

Of the 348 patients screened for this study, the incidence of SIRS after PCNL was 27%. Forty four (13%) patients required multiple tracts during their procedure however there was no statistical difference between those who did and did not develop postoperative SIRS. Similar outcomes were seen when looking at main stone composition, mean stone composition s%, and post-op imaging for residual stones. Interestingly, there was a significant difference seen for patients who had antegrade stent placement post-PCNL and positive stone culture. Fifty-three patients had antegrade stent post-PCNL. Of that group 21 (39.6%) had post-op SIRS (p=.031). Thirty-three patients had positive stone culture and 57.6% of that group had post-op SIRS (p=.001).

In this study, positive stone culture and antegrade stent placement were identified as risk factors for SIRS after PCNL. This information may allow for a more quantitative assessment of the probability of SIRS in patients post-PCNL.

Speaker: S. Bolomytis

Written by: Renai Yoon, Department of Urology, University of California-Irvine, at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark