SAFETY OF PROCALCITONIN-GUIDED PERCUTANEOUS NEPHROLITHOTOMY IN KIDNEY STONE PATIENTS WITH RECURRENT URINARY TRACT INFECTION AND ITS PERFORMANCE IN PREDICTING INFECTIOUS COMPLICATIONS

Öz

Objective: This study aimed to evaluate the safety of percutaneous nephrolithotomy (PNL) following normalization of procalcitonin (PCT) levels in kidney stone patients with recurrent urinary tract infections (rUTIs) and assess the diagnostic performance of PCT in predicting postoperative infective complications.

Materials and Methods: A prospective cohort study was conducted between January 2020 and December 2024, including 29 kidney stone patients with a history of rUTI and persistent infection despite multiple antibiotic regimens. PNL was performed after normalization of serum PCT levels (<0.25 ng/mL). PCT levels were measured preoperatively and on postoperative day 1. The primary endpoint was the development of postoperative infective complications (composite of fever >38.5°C, PCT >2.0 ng/mL with clinical signs of infection, or positive blood culture); secondary endpoints included overall complication rate, stone-free rate, and length of hospital stay. The diagnostic performance of PCT was evaluated using ROC curve analysis.

Results: The mean age was 48.1±14.4 years, with 51.7% male patients. The average stone size was 31.1±14.1 mm. extendedspectrum betalactamase (ESBL)-producing E. coli was the most common preoperative pathogen (72.4%). Preoperative PCT median value was 0.06 ng/mL (range 0.01-0.24), with all patients within normal limits. All patients underwent successful PNL (mean operative time: 78.5±15.2 minutes). Postoperatively, infectious complications occurred in 3 patients (10.3%), with no cases of sepsis or septic shock. ROC analysis revealed an AUC of 0.887 (95% CI: 0.743–1.000, p=0.032), with an optimal cut-off value of 1.5 ng/mL (sensitivity: 100%, specificity: 89.3%). The stone-free rate was 55.2%, and the mean hospital stay was 2.7±1.04 days.

Conclusion: PNL guided by PCT is a safe and effective treatment in patients with rUTI. PCT is a valuable biomarker for predicting postoperative infections and supporting surgical decision-making in high-risk patients.

Anahtar Kelimeler

• Procalcitonin
• percutaneous nephrolithotomy
• recurrent urinary tract infection
• ESBL
• infectious complications

Kaynakça

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