Skip to main content
SpringerLink
Log in

Risk factors for systemic inflammatory response syndrome following percutaneous nephrolithotomy

  • Original Paper
  • Published:
Urolithiasis Aims and scope Submit manuscript

Abstract

The aim of this study was to analyze the pre- and intraoperative risk factors that affect the development of postoperative systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL). Medical records on 317 adult patients with the complete data who underwent single-stage PCNL and followed at our center were retrospectively studied. Patients’ data were collected through a database which was collected prospectively. All patients’ vital signs were recorded hourly in the postoperative period and were divided into two groups as patients developing SIRS and not developing SIRS. There were 202 men and 115 women with a mean age of 48 ± 13.7 (range 19–82) years. There were 53 (16.7 %) in the SIRS and 264 (83.3 %) patients in the non-SIRS group. Preoperative positive urine cultures (UCs), intraoperative positive renal pelvic urine cultures (RPUCs), and stone cultures (SCs) were strongly correlated with the development of SIRS (p = 0.001). In the SIRS developers’ group, preoperative UCs, intraoperative RPUCs, and SCs were positive in 33.9, 22.5, and 28.6 % of patients, respectively, but only 9.8, 3.3, and 4.2 % for the corresponding specimens in non-SIRS group. Positive preoperative UCs, intraoperative RPUCs, and SCs are important factors indicating the development of postoperative SIRS. Appropriately treated preoperative urinary infections may not prevent infected urine at PCNL. RPUCs and SCs may be the only way to identify the causative organism and direct antimicrobial therapy, so we recommend collecting RPUCs and SCs routinely to identify the offending organism and guide treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

PCNL:

Percutaneous nephrolithotomy

SIRS:

Systemic inflammatory response syndrome

UC:

Urine culture

KUB:

Plain abdominal radiograph

USG:

Ultrasonography

CT:

Computed tomography

SC:

Stone culture

ASA:

American Society of Anesthesiologists

RPUC:

Renal pelvic urine culture

References

  1. Resorlu B, Kara C, Oguz U, Bayindir M, Unsal A (2011) Percutaneous nephrolithotomy for complex caliceal and staghorn stones in patients with solitary kidney. Urol Res 39:171–176

    Article  PubMed  Google Scholar 

  2. Zhong W, Zeng G, Wu W, Chen W, Wu K (2011) Minimally invasive percutaneous nephrolithotomy with multiple mini tracts in a single session in treating staghorn calculi. Urol Res 39:117–122

    Article  PubMed  Google Scholar 

  3. Ozden E, Mercimek MN, Bostanci Y, Yakupoglu YK, Sirtbas A, Sarikaya S (2012) Long-term outcomes of percutaneous nephrolithotomy in patients with chronic kidney disease: a single-center experience. Urology 79:990–994

    Article  PubMed  Google Scholar 

  4. Dogan HS, Guliyev F, Cetinkaya YS, Sofikerim M, Ozden E, Sahin A (2007) Importance of microbiological evaluation in management of infectious complications following percutaneous nephrolithotomy. Int Urol Nephrol 39:737–742

    Article  PubMed  Google Scholar 

  5. Lojanapiwat B, Kitirattrakarn P (2011) Role of preoperative and intraoperative factors in mediating infection complication following percutaneous nephrolithotomy. Urol Int 86:448–452

    Article  PubMed  CAS  Google Scholar 

  6. Chen L, Xu QQ, Li JX, Xiong LL, Wang XF, Huang XB (2008) Systemic inflammatory response syndrome after percutaneous nephrolithotomy: an assessment of risk factors. Int J Urol 15:1025–1028

    Article  PubMed  Google Scholar 

  7. O’Keeffe NK, Mortimer AJ, Sambrook PA, Rao PN (1993) Severe sepsis following percutaneous or endoscopic procedures for urinary tract stones. Br J Urol 72:277–283

    PubMed  Google Scholar 

  8. Charton M, Vallancien G, Veillon B, Brisset JM (1986) Urinary tract infection in percutaneous surgery for renal calculi. J Urol 135:15–17

    PubMed  CAS  Google Scholar 

  9. Rao PN, Dube DA, Weightman NC, Oppenheim BA, Morris J (1991) Prediction of septicemia following endourological manipulation for stones in the upper urinary tract. J Urol 146:955–960

    PubMed  CAS  Google Scholar 

  10. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29:1303–1310

    Article  PubMed  CAS  Google Scholar 

  11. Korets R, Graversen JA, Kates M, Mues AC, Gupta M (2011) Post-percutaneous nephrolithotomy systemic inflammatory response: a prospective analysis of preoperative urine, renal pelvic urine and stone cultures. J Urol 186:1899–1903

    Article  PubMed  Google Scholar 

  12. Levy MM, Fink MP, Marshall JC et al (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 31:1250–1256

    Article  PubMed  Google Scholar 

  13. Bone RC, Balk RA, Cerra FB et al (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101:1644–1655

    Article  PubMed  CAS  Google Scholar 

  14. Draga RO, Kok ET, Sorel MR, Bosch RJ, Lock TM (2009) Percutaneous nephrolithotomy: factors associated with fever after the first postoperative day and systemic inflammatory response syndrome. J Endourol 23:921–927

    Article  PubMed  Google Scholar 

  15. Mariappan P, Smith G, Moussa SA, Tolley DA (2006) One week of ciprofloxacin before percutaneous nephrolithotomy significantly reduces upper tract infection and urosepsis: a prospective controlled study. BJU Int 98:1075–1079

    Article  PubMed  Google Scholar 

  16. Margel D, Ehrlich Y, Brown N, Lask D, Livne PM, Lifshitz DA (2006) Clinical implication of routine stone culture in percutaneous nephrolithotomy: a prospective study. Urology 67:26–29

    Article  PubMed  CAS  Google Scholar 

  17. Mariappan P, Smith G, Bariol SV, Moussa SA, Tolley DA (2005) Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy: a prospective clinical study. J Urol 173:1610–1614

    Article  PubMed  Google Scholar 

  18. Sharifi Aghdas F, Akhavizadegan H, Aryanpoor A, Inanloo H, Karbakhsh M (2006) Fever after percutaneous nephrolithotomy: contributing factors. Surg Infect (Larchmt) 7:367–371

    Article  Google Scholar 

  19. Gonen M, Turan H, Ozturk B, Ozkardes H (2008) Factors affecting fever following percutaneous nephrolithotomy: a prospective clinical study. J Endourol 22:2135–2138

    Article  PubMed  Google Scholar 

  20. Aron M, Goel R, Gupta NP, Seth A (2005) Incidental detection of purulent fluid in kidney at percutaneous nephrolithotomy for branched renal calculi. J Endourol 19:136–139

    Article  PubMed  Google Scholar 

  21. Dogan HS, Sahin A, Cetinkaya Y, Akdogan B, Ozden E, Kendi S (2002) Antibiotic prophylaxis in percutaneous nephrolithotomy: prospective study in 81 patients. J Endourol 16:649–653

    Article  PubMed  Google Scholar 

  22. Vorrakitpokatorn P, Permtongchuchai K, Raksamani EO, Phettongkam A (2006) Perioperative complications and risk factors of percutaneous nephrolithotomy. J Med Assoc Thai 89:826–833

    PubMed  Google Scholar 

  23. Bratell S, Brorson JE, Grenabo L, Hedelin H, Pettersson S (1990) The bacteriology of operated renal stones. Eur Urol 17:58–61

    PubMed  CAS  Google Scholar 

  24. Mariappan P, Loong CW (2004) Midstream urine culture and sensitivity test is a poor predictor of infected urine proximal to the obstructing ureteral stone or infected stones: a prospective clinical study. J Urol 171:2142–2145

    Article  PubMed  Google Scholar 

  25. Ziaee SA, Kazemi B, Moghaddam SM et al (2008) A study of febrile versus afebrile patients after percutaneous nephrolithotomy regarding bacterial etiologic factors through blood and urine cultures and 16S rRNA detection in serum. J Endourol 22:2717–2721

    Article  PubMed  Google Scholar 

  26. Cadeddu JA, Chen R, Bishoff J et al (1998) Clinical significance of fever after percutaneous nephrolithotomy. Urology 52:48–50

    Article  PubMed  CAS  Google Scholar 

  27. Opal SM, Scannon PJ, Vincent JL et al (1999) Relationship between plasma levels of lipopolysaccharide (LPS) and LPS-binding protein in patients with severe sepsis and septic shock. J Infect Dis 180:1584–1589

    Article  PubMed  CAS  Google Scholar 

  28. Kumar S, Bag S, Ganesamoni R, Mandal AK, Taneja N, Singh SK (2012) Risk factors for urosepsis following percutaneous nephrolithotomy: role of 1 week of nitrofurantoin in reducing the risk of urosepsis. Urol Res 40:79–86

    Article  PubMed  CAS  Google Scholar 

  29. Thomas LL, Sturk A, Buller HR, ten Cate JW, Spijker RE, ten Cate H (1984) Comparative investigation of a quantitative chromogenic endotoxin assay and blood cultures. Am J Clin Pathol 82:203–206

    PubMed  CAS  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Urology, Faculty of Medicine, Ondokuz Mayis University, 55139, Samsun, Turkey

    Tunc Erdil, Yakup Bostanci, Ender Ozden, Fatih Atac, Yarkin Kamil Yakupoglu, Ali Faik Yilmaz & Saban Sarikaya

Authors
  1. Tunc Erdil
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yakup Bostanci
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ender Ozden
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fatih Atac
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yarkin Kamil Yakupoglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ali Faik Yilmaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Saban Sarikaya
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yakup Bostanci.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Erdil, T., Bostanci, Y., Ozden, E. et al. Risk factors for systemic inflammatory response syndrome following percutaneous nephrolithotomy. Urolithiasis 41, 395–401 (2013). https://doi.org/10.1007/s00240-013-0570-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00240-013-0570-y

Keywords

Search

Navigation