Percutaneous nephrolithotomy and modern aspects of complications and antibiotic treatment
Wagenius, Magnus LU ; Borglin, Jasmine ; Popiolek, Marcin ; Forsvall, Andreas LU
; Stranne, Johan
and Linder, Adam
LU
(2020)
In Scandinavian Journal of Urology
54(2).
p.162-170
- Abstract
Objective: The incidence of urinary stones is increasing across the globe. Surgical treatment includes extracorporal shock-wave lithotripsy (ESWL), ureterolithotripsy (URS), percutaneous nephrolitotomy (PCNL) and rarely open surgery. This single center study describes complications to PCNL focusing on infections, bacterial growth/resistance and antibiotic prophylaxis/treatment. Materials and methods: All patients treated for kidney stones with PCNL at Ängelholm Hospital in north-western Scania, Sweden from January 2009 to December 2015 were included. A dipstick test and a bacterial culture was made on all patients. Kidney stones were analysed for composition and cultured for bacteria. Results: In total, 186 patients underwent PCNL, all... (More)
Objective: The incidence of urinary stones is increasing across the globe. Surgical treatment includes extracorporal shock-wave lithotripsy (ESWL), ureterolithotripsy (URS), percutaneous nephrolitotomy (PCNL) and rarely open surgery. This single center study describes complications to PCNL focusing on infections, bacterial growth/resistance and antibiotic prophylaxis/treatment. Materials and methods: All patients treated for kidney stones with PCNL at Ängelholm Hospital in north-western Scania, Sweden from January 2009 to December 2015 were included. A dipstick test and a bacterial culture was made on all patients. Kidney stones were analysed for composition and cultured for bacteria. Results: In total, 186 patients underwent PCNL, all receiving perioperative antibiotics. Thirty percent (56/186) had a positive urinary culture taken before surgery and 33.3% (62/186) had positive stone culture. The concordance between urinary and stone culture was 57.1%. Both positive stone and urinary culture increased the risk of complications after surgery (p = 0.002 and p = 0.017, respectively). Complications occurred in 16% (30/186). Eight patients (4.3%) developed sepsis. The most common bacteria in urine were Enterococcus faecalis and Escherichia coli, both 20%. The most common stone-bacteria reported was Enterococcus faecalis (26%). Conclusion: This study has a total complication rate of 16%, approximately 10% of those are severe. The most common complication to PCNL was infection (60%), followed by bleeding (5.4%), reoperation (1.6%) and pain (0.5%). The high prevalence of E. faecalis might need to be considered, however the results should be validated in a larger cohort, possibly with a higher rate of antibiotic resistance, before a change of guidelines regarding prophylactic antibiotics could be proposed.
(Less)
- author
- Wagenius, Magnus
LU
; Borglin, Jasmine
; Popiolek, Marcin
; Forsvall, Andreas
LU
; Stranne, Johan
and Linder, Adam
LU
- organization
- publishing date
- 2020-03-25
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- complications, infection, ureteric stone, Ureteroscopy
- in
- Scandinavian Journal of Urology
- volume
- 54
- issue
- 2
- pages
- 9 pages
- publisher
- Taylor & Francis
- external identifiers
-
- scopus:85082459516
- pmid:32208808
- ISSN
- 2168-1805
- DOI
- 10.1080/21681805.2020.1740316
- language
- English
- LU publication?
- yes
- id
- 328e3f9f-a550-4bfb-9957-c88aa35ddf05
- date added to LUP
- 2020-04-28 14:46:09
- date last changed
- 2024-03-20 08:17:29
@article{328e3f9f-a550-4bfb-9957-c88aa35ddf05,
abstract = {{<p>Objective: The incidence of urinary stones is increasing across the globe. Surgical treatment includes extracorporal shock-wave lithotripsy (ESWL), ureterolithotripsy (URS), percutaneous nephrolitotomy (PCNL) and rarely open surgery. This single center study describes complications to PCNL focusing on infections, bacterial growth/resistance and antibiotic prophylaxis/treatment. Materials and methods: All patients treated for kidney stones with PCNL at Ängelholm Hospital in north-western Scania, Sweden from January 2009 to December 2015 were included. A dipstick test and a bacterial culture was made on all patients. Kidney stones were analysed for composition and cultured for bacteria. Results: In total, 186 patients underwent PCNL, all receiving perioperative antibiotics. Thirty percent (56/186) had a positive urinary culture taken before surgery and 33.3% (62/186) had positive stone culture. The concordance between urinary and stone culture was 57.1%. Both positive stone and urinary culture increased the risk of complications after surgery (p = 0.002 and p = 0.017, respectively). Complications occurred in 16% (30/186). Eight patients (4.3%) developed sepsis. The most common bacteria in urine were Enterococcus faecalis and Escherichia coli, both 20%. The most common stone-bacteria reported was Enterococcus faecalis (26%). Conclusion: This study has a total complication rate of 16%, approximately 10% of those are severe. The most common complication to PCNL was infection (60%), followed by bleeding (5.4%), reoperation (1.6%) and pain (0.5%). The high prevalence of E. faecalis might need to be considered, however the results should be validated in a larger cohort, possibly with a higher rate of antibiotic resistance, before a change of guidelines regarding prophylactic antibiotics could be proposed.</p>}},
author = {{Wagenius, Magnus and Borglin, Jasmine and Popiolek, Marcin and Forsvall, Andreas and Stranne, Johan and Linder, Adam}},
issn = {{2168-1805}},
keywords = {{complications; infection; ureteric stone; Ureteroscopy}},
language = {{eng}},
month = {{03}},
number = {{2}},
pages = {{162--170}},
publisher = {{Taylor & Francis}},
series = {{Scandinavian Journal of Urology}},
title = {{Percutaneous nephrolithotomy and modern aspects of complications and antibiotic treatment}},
url = {{http://dx.doi.org/10.1080/21681805.2020.1740316}},
doi = {{10.1080/21681805.2020.1740316}},
volume = {{54}},
year = {{2020}},
}