Many of these stones are secondary to urinary tract infections, and ensuring that the patient is abacteriuric preoperatively is important. However, even with a sterile urine culture these patients can have a low, but real, risk of developing septicemia postoperatively.
A group of researchers in India performed a prospective randomized controlled study of 101 patients undergoing primary percutaneous nephrolithotomy with a sterile preoperative urine culture. Half of the study group received oral nitrofurantoin twice a day for one week preoperatively (NFT group) and the other half of the patients did not have outpatient antibiotic therapy. All the patients received a single dose of IV cephalosporin at the induction of anesthesia for their operative procedure. Intraoperatively all patients had renal pelvic urine and stone fragments collected for culture. Patients were monitored post-operatively for fever >38o C and/or WBC >12,000, which were considered hard criteria for the presence of systemic inflammatory response syndrome (SIRS). Both the NFT group (48 patients) and the Control group (53 patients) were comparable for age, gender, stone burden, degree of hydronephrosis, duration of operation and intraoperative blood loss. However, in the NFT prophylaxis group there was significantly lower positive pelvic urine culture (0% vs. 9.8%, p=0.001), lower positive stone cultures (8.3% vs. 30.2%, p=0.001), lower endotoxemia (17.5% vs. 41.9%, p=0.016), and SIRS (19% vs. 49%, p=0.01) compared to the control group, respectively.
This study is unique in that it is the only prospective randomized controlled trial on the issue of infection rates post percutaneous nephrolithotomy. Multi-institutional confirmation of these findings would be very important, but this could have significant clinical implications for patients undergoing PCNL.
Bag S, Kumar S, Taneja N, Sharma V, Mandal AK, Singh SK
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Urology. 2011 Jan;77(1):45-9
10.1016/j.urology.2010.03.025
PubMed Abstract
PMID: 20570319
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