Infectious outcomes of nephrostomy drainage before percutaneous nephrolithotomy compared to concurrent access

Area of Science:

• Urology
• Infectious Disease
• Nephrology

Background:

• Percutaneous nephrolithotomy (PCNL) is a common procedure for kidney stone removal.
• Patients undergoing PCNL, especially those with a history of infection or complex stones, are at increased risk for sepsis.
• Effective strategies to mitigate infectious complications are essential.

Purpose of the Study:

• To evaluate whether preoperative percutaneous nephrostomy drainage and culture-specific antibiotic treatment reduce sepsis rates in high-risk PCNL patients.
• To compare sepsis rates between PCNL with prior nephrostomy drainage versus concurrent percutaneous renal access.

Main Methods:

• Retrospective review of 219 PCNL cases performed by a single surgeon.
• Data collected included patient infection history, urine and stone cultures, and sepsis/systemic inflammatory response syndrome (SIRS) events.
• Patients were divided into two groups: preplaced nephrostomy drainage (Group 1) and concurrent percutaneous renal access (Group 2).

Main Results:

• Group 1 (preplaced drainage) had a higher rate of positive stone cultures (64.2%) compared to Group 2 (25.7%).
• Preoperative renal urine culture concordance with stone culture was higher than lower urinary tract culture concordance.
• No sepsis/SIRS episodes occurred in Group 1, while Group 2 experienced a 5.9% sepsis/SIRS rate (p=0.043).

Conclusions:

• Preoperative nephrostomy drainage with targeted antibiotic therapy may decrease postoperative infectious complications in high-risk PCNL patients.
• Stone culture is vital, as many high-risk patients present with positive stone cultures.
• Further prospective studies are warranted to validate these findings.