Perkütan nefrolitotomi yapılan hastalarda preoperatif nefrostomi ve double j stent yerleştirilmesinin infeksiyöz sonuçlara etkisi: Tek merkezli çalışma

Year 2018, Volume: 13 Issue: 1, 23 - 27, 01.02.2018

Ertuğrul Şefik , Özgü Aydoğdu Salih Polat İbrahim Halil Bozkurt Tarık Yonguç Serkan Yarımoğlu Deniz Bolat Tansu Değirmenci Çetin Dinçel

Abstract

Amaç: Perkütan nefrolitotomi yapılan hastalarda preoperatif nefrostomi ve double j stent yerleştirilmesinin infeksiyöz sonuçlara etkisini değerlendirmek. 

Gereç ve Yöntemler: Kliniğimizde Ocak 2012-Ocak 2016 arasında perkütan nefrolitotomi yapılan 652 hasta çalışmaya dahil edildi. Hastalar 3 gruba ayırıldı. Grup 1 de preoperatif herhangi bir stent veya nefrostomi takılmayan 585 hasta, grup 2’de PNL öncesi nefrostomi takılan 34 hasta, grup 3’de ise PNL öncesi double j stent takılan 33 hasta vardı. Preoperatif idrar kültürü, preoperatif nefrostomi kültürü, intraoperatif renal pelvis kültürü, taş kültürü ve postoperatif 15. gün idrar kültürü tüm hastalardan alındı. WBC sayımı preoperatif ve postoperatif 1. gün tüm hastalara, postoperatif ateşi olan hastalara ise günlük olarak yapıldı. Bütün hastalar postoperatif dönemde sistemik inflamatuar cevap sendromu(SIRS) ve sepsis bulguları açısından takip edildi. 

Bulgular: Preoperatif nefrostomi takılan grupta preoperatif idrar kültürü ve postoperatif 15.gün idrar kültürü anlamlı olarak daha yüksekti. Sepsis oranları grup 1, 2 ve 3’de sırasıyla %3,4, %5,8 ve %6,1 idi. Gruplar arasında SIRS ve sepsis gelişimi açısından anlamlı fark izlenmedi. Hastanede kalış süresi SIRS gelişimi açısından tek risk faktörü olarak bulundu. Postoperatif nefrostomi süresi, hastanede kalış süresi, preoperatif pozitif idrar kültürü, pozitif taş kültürü ve irrigasyon volümü postoperatif sepsis gelişmesi açısından risk faktörleri olarak bulundu. 

Sonuç: PNL yapılan hastalarda, postoperatif sepsis gelişiminde preoperatif olarak takılan nefrostominin veya double j stent yerleştirilmesinin etkisi yoktur. 

Keywords

perkütan nefrolitotomi , perkütan nefrostomi , üreteral stent , sepsis

The effect of preoperative nephrostomy and double j catheterization on infectious outcomes in patients who underwent percutaneous nephrolithotomy: Single center experience

Abstract

Object: We aimed to investigate the effect of preoperative nephrostomy or double J stent insertion on infectious outcomes in patients undergoing percutaneous nephrolithotomy. 

Materials and Methods: A total of 652 patients who underwent percutaneous nephrolithotomy between January 2012 to January 2016 in our clinic included in this study. There were three groups. Group 1 included 585 patients who underwent concurrent percutaneous renal access during PCNL, group 2 included 34 patients who had nephrostomy drainage before PCNL and group 3 included 33 patients in whom renal pelvis drainage was established with D-J catheter before PCNL operation. Preoperative urine culture, preoperative nephrostomy culture, intraoperative renal pelvis culture, stone culture and postoperative fifteenth day urine culture were obtained from all patients. WBC counting performed preoperative and postoperative first day and followed daily for patients with fever. All patients were followed up postoperatively for signs of systemic inflammatory response syndrome (SIRS) and sepsis. 

Results: Positive preoperative urine culture and positive postoperative 15th day urine culture was significantly higher in preoperative nephrostomy group. There was no significant difference between the groups in terms of SIRS and sepsis. Hospitalization time is the only factor for postoperative SIRS. Postoperative nephrostomy time, hospitalization time, preoperative (+) urine culture, positive stone culture and irrigation volume was found to be the risk factors for postoperative sepsis. 

Conclusion: We found that preoperative nephrostomy drainage or preoperative double j stenting does not affect postoperative sepsis and postoperative SIRS in patients undergoing percutaneous nephrolithotomy. 

Keywords

nephrolithotomy , percutaneous nephrostomy , ureteral stent , sepsis

References

• 1. de la Rosette J, Assimos D, Desai M et al. CROES PCNL Study Group The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients. J Endourol 2011 25:11–17.
• 2. O’Keeffe NK, Mortimer AJ, Sambrook PA et al. Severe sepsis following percutaneous or endoscopic procedures for urinary tract stones. Br J Urol 199372:277–283.
• 3. Korets R, Graversen JA, Kates M et al. Postpercutaneous nephrolithotomy systemic inflammatory response: a prospective analysis of preoperative urine, renal pelvic urine and stone cultures. J Urol 2011;186: 1899.
• 4. Kumar S, Bag S, Ganesamoni R et al. Risk factors for urosepsis following percutaneous nephrolithotomy: role of 1 week of nitrofurantoin in reducing the risk of urosepsis. Urol Res 2012; 40: 79.
• 5. Benson AD, Juliano TM, Miller NL. Infectious outcomes of nephrostomy drainage before percutaneous nephrolithotomy compared to concurrent access. J Urol 2014;192:770– 774.
• 6. Levy MM, Fink MP, Marshall JC et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003 31:1250–1256.
• 7. Sivalingam S, Stormont IM, Nakada SY Contemporary Practice Patterns in the Management of Acute Obstructing Ureteral Stones. J Endourol 2015;29:736-40.
• 8. Koras O, Bozkurt IH, Yonguc T et al. Risk factors for postoperative infectious complications following percutaneous nephrolithotomy: a prospective clinical study. Urolithiasis 2015;43:55-60.
• 9. Türk C, Knoll T, Petrik A et al. European Association of Urology Guidelines on urolithiasis 2016
• 10. Ramsey S. Robertson A, Ablett MJ et al. Evidence-based drainage of infected hydronephrosis secondary to ureteric calculi. J Endourol 2010; 24: 185.
• 11. Lynch, M.F, Anson KM, Patel U. Percutaneous nephrostomy and ureteric stent insertion for acute renal deobstruction: Consensus based guidance. British Journal of Medical & Surgical Urology 2008; 1: 120.
• 12. Gutierrez J, Smith A, Geavlete P et al. Urinary tract infections and post-operative fever in percutaneous nephrolithotomy. World J Urol 2013;31:1135-40.
• 13. Pearle MS, Pierce HL, Miller GL et al. Optimal method of urgent decompression of the collecting system for obstruction and infection due to ureteral calculi. J Urol 1998;160:1260–4.