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WCE 2011 - The CROES Percutaneous Nephrolithotomy Global Study: Urinary tract infections and post-operative fever in percutaneous nephrolithotomy - Session Highlights

KYOTO, JAPAN (UroToday.com) - Percutaneous nephrolithotomy (PNL) is the established treatment for large renal calculi, yet concrete risk factors for postoperative complications, such as fever and blood transfusion, are still being delineated.

In 2 studies presenting data from the CROES PCNL Global Study database, the authors sought to do just that. In the report by Gutierrez and colleagues, 5,803 consecutive patients were assessed for the presence of preoperative bladder urine culture and post-operative fever. A total of 865 patients (16.2%) were found to be positive on culture. Of the patients with a positive culture, 18.2% went on to develop post-operative fever compared to only 8.8% of those found to have a negative culture. Furthermore, a bladder culture positive for gram-negative bacteria was more likely to result in post-operative fever than gram-positive bacteria (19.4%-23.8% vs 9.7-14.5%). Other risk factors included staghorn calculus and diabetes. In the second study, outcomes were assessed in relation to stone location and size.

In the study by Xue, et al., of 1448 stones >2cm, the majority (83%) were 2-3 cm in size, followed by 3-4cm (14%), and 4-6cm (3%) with the majority located in the renal pelvis (73%). Lower stone free rates, higher post-operative fever and blood transfusion rates were seen with increasing stone diameter. Interestingly, as American Society of Anesthesiologists (ASA) score rose from I to III, so did the proportion of stones seen in the calyceas. In patients with an ASA score of III, the number of calyceal stones was 15.7% compared to renal pelvis stones (5.7%). The importance of this lies in that across the range of Clavien scores, complication rates were higher in patients with calyceal stones compared to a renal pelvis location. The authors did not report whether this finding was a function of the associated higher ASA scores in patients with calyceal stones.

Also:
Management of large renal stones in the CROES Percutaneous Nephrolithotomy Global Study
by Wei Xue

 

Presented by Jorge Gutierrez at the 29th World Congress of Endourology & SWL (WCE) - November 30 - December 3, 2011 - Kyoto International Conference Center - Kyoto, Japan


Reported for UroToday by Joseph Graversen, Fellow Minimally Invasive Surgery and Endourology, University of California-Irvine Medical Center, Irvine, CA


 

The opinions expressed in this article are those of the UroToday.com Contributing Medical Editor and do not necessarily reflect the viewpoints of the Endourological Society.


 



 

 



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