ABSTRACT
OBJECTIVE@#To compare the value of intraoperative stone culture (IOSC) and intraoperative pelvic urine culture (IOPUC) versus pre-operative urine culture (POBUC) in the early detection of systemic inflammatory response syndrome (SIRS) in patients undergoing percutaneous nephrolithotomy (PCNL). @*METHODS@#This is a prospective clinical study which includes all adult patients undergoing PCNL. All patients who were operated on should have a negative preoperative urine culture (POBUC) results. Intraoperative pelvic urine culture (IOPUC) and stone culture (IOSC) were extracted and results were interpreted if they were contributory in acquiring SIRS post operatively.@*RESULTS@#The demographics of each patient such as age, sex, having diabetes, laterality, location of calculi had no correlation to the development of SIRS. Patients with positive IOPUC and IOSC results yielded a significant value with odds of having SIRS 4.71 and 13.74, respectively.@*CONCLUSION@#In the study, all patients underwent PCNL with negative preoperative urine culture findings. Having intraoperative cultures, IOPUC and IOSC, can definitely help predict the occurrence of SIRS and ultimately be one step ahead in the management of these patients to decrease overall morbidity and mortality.
Subject(s)
Nephrolithotomy, Percutaneous , Systemic Inflammatory Response Syndrome , Postoperative PeriodABSTRACT
@#The current standard in the management of large burden renal stones is conventional percutaneous nephrolithotomy. Mini-percutaneous nephrolithotomy (mini-PCNL) is a procedure developed to decrease complications of standard PCNL by decreasing the size of access. Recent studies have shown high stone free rates with minimal complications in utilizing mini-PCNL in larger stones. @*OBJECTIVE@#This study aims to assess the safety and efficacy of mini-PCNL for stones with sizes 2 cm and above versus standard PCNL.@*METHODS@#This is a meta-analysis comparing mini-PCNL and standard PCNL in the management of renal stones 2 cm and above. A PUBMED search was done to acquire randomized controlled trials (RCTs), prospective and retrospective studies of mini-PCNL and standard PCNL assessing large burden renal stones, defined as 2 cm and above. Two authors independently assessed the studies for selection. Comparison of mini-PCNL and standard PCNL was done according to following parameters: stone-free rate, operative time, postoperative decrease in hemoglobin levels, length of hospital stay, rate of transfusion, occurrence of fever, postoperative pain scores, and occurrence of urine leakage.@*RESULTS@#Results of this meta-analysis showed that standard percutaneous nephrolithotomy has an advantage over mini percutaneous nephrolithotomy only in terms of having a shorter operative time for larger stones (MD: 8.44 min, 95% CI 6.36 – 10.52 min, p < 0.00001). No difference was found in the outcomes of postoperative pain scores (MD 0.19 VAS score, %CI 0.16 – 0.54, p = 0.29), occurrence of postoperative fever (OR 0.33, 95% CI 0.18 – 0.61, p = 0.06) and the stone-free rate (OR 0.97, 95% CI 0.67 – 1.41, p = 0.88). Mini-percutaneous nephrolithotomy has advantage over standard percutaneous nephrolithotomy for large-burden stones in terms of shorter length of postoperative hospital stay (MD 1.44 day, 95% CI 1.22-1.66, P <0.00001), lower hemoglobin drop (MD 0.48 mg/dl, 95% CI 0.39–0.66, p < 0.00001), lower rate of transfusion (OR 0.40, 95% CI 0.20 – 0.99, p = 0.01), urine leakage (OR 0.11, 95% CI 0.03 – 0.39, p = 0.0008) and an overall lower occurrence of complications (OR 0.42, 95% CI 0.28 – 0.62, p < 0.0001).@*CONCLUSION@#Mini-percutaneous nephrolithotomy is a safe and effective intervention in large-burden stones 2 cm in size and above.