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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.

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Please use this url to cite or link to this publication:
author
organization
publishing date
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
  • pmid:32208808
  • scopus:85082459516
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
2020-04-29 04:23:46
@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},
  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},
}