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Risk factors for sepsis after percutaneous renal stone surgery

Nature Reviews Urology volume 10, pages 598–605 (2013)Cite this article

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Abstract

Since its introduction into the endourologist's armamentarium almost 40 years ago, percutaneous nephrolithotomy (PCNL) has become the standard of care for patients with large-volume nephrolithiasis. Postoperative infection is one of the most common complications of the procedure, and postoperative sepsis is one of the most detrimental. A number of factors have been found to increase the risk of postoperative sepsis. These include patient characteristics that are known preoperatively, such as urine culture obtained from the bladder or from the renal pelvis if percutaneous access to the renal pelvis is obtained in advance to the procedure. Neurogenic bladder dysfunction secondary to spinal cord injury and anatomical renal abnormalities, such as pelvicalyceal dilatation, have also been associated with increased incidence of fever and sepsis after the procedure. Several intraoperative factors, such as the average renal pressure sustained during PCNL and the operative time, also seem to increase the risk of sepsis. Finally, the contribution of postoperative factors, such as presence of a nephrostomy tube or a urethral catheter, has also been investigated. A short preoperative course of antibiotics has been found to significantly decrease the rate of postoperative fever and sepsis. Novel agents targeted at sepsis prevention and treatment, such as anti-endotoxin antibodies and cholesterol-lowering drugs statins, are currently under investigation.

Key Points

  • Sepsis after percutaneous nephrolithotomy (PCNL) is uncommon but potentially life threatening

  • The most common risk factors associated with post-PCNL sepsis are bacteriuria (in bladder urine or renal pelvis urine), stone size and operative time

  • Patient groups with unique anatomical characteristics, such as horseshoe kidney or spinal cord injury, might be at increased risk of sepsis

  • Close monitoring is important in patients with risk factors for sepsis as they might require more intense supportive care or admission to an intensive care unit

  • Further studies are necessary to understand how to prevent sepsis in high-risk patients

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Authors and Affiliations

  1. Department of Urology, Massachusetts General Hospital, Harvard Medical School, GRB 1102, 55 Fruit Street, Boston, 02114, MA, USA

    Evgeniy I. Kreydin & Brian H. Eisner

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E. I. Kreydin and B. H. Eisner researched data for the article, contributed to discussion of content, wrote the article and reviewed the manuscript prior to submission.

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Correspondence to Brian H. Eisner.

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B. H. Eisner declares that he has acted as a consultant for ACMI, Boston Scientific and PercSys and that he is a stockholder/director of the Ravine Group. E. I. Kreydin declares no competing interests.

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Kreydin, E., Eisner, B. Risk factors for sepsis after percutaneous renal stone surgery. Nat Rev Urol 10, 598–605 (2013). https://doi.org/10.1038/nrurol.2013.183

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