Percutaneous nephrolithotomy and modern aspects of complications and antibiotic treatment

Abstract

<b>Objective:</b> 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.<b>Materials and methods:</b> 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.<b>Results:</b> 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 (<i>p</i> = 0.002 and <i>p</i> = 0.017, respectively). Complications occurred in 16% (30/186). Eight patients (4.3%) developed sepsis. The most common bacteria in urine were <i>Enterococcus faecalis</i> and <i>Escherichia coli,</i> both 20%. The most common stone-bacteria reported was <i>Enterococcus faecalis</i> (26%).<b>Conclusion:</b> 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 <i>E. faecalis</i> 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.