Onur Kaygısız1, Nihat Satar2, Ali Güneş3, Hasan Serkan Doğan4, Ahmet Erözenci5, Ender Özden6, Mehmet Mesut Pişkin7, Deniz Demirci8, Serdar Toksöz9, Tufan Çiçek10, Serhat Gürocak11, Hakan Kılıçarslan12, Oktay Nazlı13, Aykut Kefi14, Volkan İzol2, Ali Beytur3, Şaban Sarıkaya6, Serdar Tekgül4, Bülent Önal5. 1. Department of Urology, Uludağ University Faculty of Medicine, Bursa, Turkey. Electronic address: onurkygsz@yahoo.com. 2. Department of Urology, Cukurova University Faculty of Medicine, Adana, Turkey. 3. Department of Urology, İnönü University Faculty of Medicine, Malatya, Turkey. 4. Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey. 5. Department of Urology, Istanbul University, Cerrahpasa Faculty of Medicine, Istanbul, Turkey. 6. Department of Urology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey. 7. Department of Urology, Necmetin Erbakan University, Meram Faculty of Medicine, Konya, Turkey. 8. Department of Urology, Erciyes University Faculty of Medicine, Kayseri, Turkey. 9. Department of Urology, Baskent University Faculty of Medicine, Ankara, Turkey. 10. Department of Urology, Baskent University Faculty of Medicine, Konya, Turkey. 11. Department of Urology, Gazi University Faculty of Medicine, Ankara, Turkey. 12. Department of Urology, Uludağ University Faculty of Medicine, Bursa, Turkey. 13. Department of Urology, Ege University Faculty of Medicine, İzmir, Turkey. 14. Department of Urology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey.
Abstract
BACKGROUND: Predictive tables and scoring systems can predict stone clearance. However, there is a paucity of evidence regarding the prediction of complications during percutaneous nephrolithotomy (PCNL), particularly in children, which remains under-researched. To our knowledge, no studies have evaluated the risk factors for febrile urinary tract infection (FUTI) after pediatric PCNL. OBJECTIVES: To assess the predictive factors of FUTI in prepubertal children after PCNL and determine whether any prophylactic cephalosporins are superior for decreasing the FUTI rate. STUDY DESIGN: Data from 1157 children who underwent PCNL between 1991 and 2012 were retrieved from the multicenter database of the Turkish Pediatric Urology Society. Children >12 years of age were excluded, leaving 830 children (364 girls, 466 boys). Data were analyzed according to the presence of FUTI and compared between the FUTI and non-FUTI groups. RESULTS: Mean age was 6.46 ± 3.38 years. Twenty-nine (3.5%) children had FUTI which was confirmed by urine culture. FUTI occurred more frequently in young children (5.5%) than school-age children (2.4%). In univariate analysis, there were significant differences between the FUTI and non-FUTI groups regarding age, cephalosporin subgroup (first, second and third generation cephalosporin), side of PCNL, staghorn stones, tract size, operative time, postoperative ureteral catheter usage, perioperative complications (SATAVA), and blood transfusion. Multivariate analysis revealed that age, side of PCNL, staghorn stones, tract size, operative time, and blood transfusion were independent predictors of FUTI. DISCUSSION: The smaller tract size could cause FUTI with poor fluid drainage that may lead to elevate renal pelvic pressure and trigger bacteremia-causing pyelovenous backflow. Filling the calyx and renal pelvis by a staghorn stone and the resulting obstruction of fluid drainage may elevate intrarenal pelvis pressure. Longer operative time is likely to increase renal pelvic pressure over longer periods, which may account for FUTI after pediatric PCNL. CONCLUSIONS: Younger age, right-sided PCNL, staghorn stones, mini-PCNL, longer operative time, and blood transfusion are risk factors for FUTI. First-, second-, and third-generation cephalosporins are equally effective for prophylaxis in prepubertal children undergoing PCNL.
BACKGROUND: Predictive tables and scoring systems can predict stone clearance. However, there is a paucity of evidence regarding the prediction of complications during percutaneous nephrolithotomy (PCNL), particularly in children, which remains under-researched. To our knowledge, no studies have evaluated the risk factors for febrile urinary tract infection (FUTI) after pediatric PCNL. OBJECTIVES: To assess the predictive factors of FUTI in prepubertal children after PCNL and determine whether any prophylactic cephalosporins are superior for decreasing the FUTI rate. STUDY DESIGN: Data from 1157 children who underwent PCNL between 1991 and 2012 were retrieved from the multicenter database of the Turkish Pediatric Urology Society. Children >12 years of age were excluded, leaving 830 children (364 girls, 466 boys). Data were analyzed according to the presence of FUTI and compared between the FUTI and non-FUTI groups. RESULTS: Mean age was 6.46 ± 3.38 years. Twenty-nine (3.5%) children had FUTI which was confirmed by urine culture. FUTI occurred more frequently in young children (5.5%) than school-age children (2.4%). In univariate analysis, there were significant differences between the FUTI and non-FUTI groups regarding age, cephalosporin subgroup (first, second and third generation cephalosporin), side of PCNL, staghorn stones, tract size, operative time, postoperative ureteral catheter usage, perioperative complications (SATAVA), and blood transfusion. Multivariate analysis revealed that age, side of PCNL, staghorn stones, tract size, operative time, and blood transfusion were independent predictors of FUTI. DISCUSSION: The smaller tract size could cause FUTI with poor fluid drainage that may lead to elevate renal pelvic pressure and trigger bacteremia-causing pyelovenous backflow. Filling the calyx and renal pelvis by a staghorn stone and the resulting obstruction of fluid drainage may elevate intrarenal pelvis pressure. Longer operative time is likely to increase renal pelvic pressure over longer periods, which may account for FUTI after pediatric PCNL. CONCLUSIONS: Younger age, right-sided PCNL, staghorn stones, mini-PCNL, longer operative time, and blood transfusion are risk factors for FUTI. First-, second-, and third-generation cephalosporins are equally effective for prophylaxis in prepubertal children undergoing PCNL.
Authors: Dilip K Mishra; Sonia Bhatt; Sundaram Palaniappan; Talamanchi V K Reddy; Vinothkumar Rajenthiran; Y L Sreeranga; Madhu S Agrawal Journal: Asian J Urol Date: 2021-06-09