Post-percutaneous nephrolithotomy septic shock and severe hemorrhage: a study of risk factors.

Abstract

OBJECTIVE:

To identify the risk factors predicting septic shock and severe hemorrhage in percutaneous nephrolithotomy (PCNL).

METHODS:

We retrospectively analyzed 420 renal calculi patients who underwent ultrasound-guided PCNL from March 2005 to May 2011. Data on patients who experienced infectious shock requiring anti-shock therapy and severe renal bleeding requiring angiographic renal embolization or nephrectomy were compared with other patients using univariate analyses.

RESULTS:

Of 420 patients, 10 (2.4%) suffered septic shock and 4 (1%) had severe hemorrhage. The two significant risk factors for infectious shock were preoperative urine white blood cell count and operation time. For severe bleeding the absence of hydronephrosis and puncture time were significant risk factors. Operation time >90 min was associated with both septic shock and severe renal bleeding (p = 0.017). In contrast, the risk of encountering severe renal bleeding was higher if a nephroscope rather than a ureteroscope was used (p = 0.045).

CONCLUSIONS:

Operation time was a risk factor for both septic shock and severe hemorrhage. The patients without hydronephrosis before operation were more likely to suffer severe renal bleeding. Reducing intraoperative puncture time can reduce the probability of severe post-PCNL hemorrhage. The use of a comparatively gross nephroscope passage was likely to result in severe renal bleeding.

• Authors: Yanbo Wang, Fengming Jiang, Yan Wang, Yuchuan Hou, Haifeng Zhang, Qihui Chen, Ning Xu, Zhihua Lu, Jinghai Hu, Ji Lu, Xiaoqing Wang, Yuanyuan Hao, Chunxi Wang
• Journal: Urologia internationalis (Urol Int) Vol. 88 Issue 3 Pg. 307-10 ( 2012) ISSN: 1423-0399 [Electronic] Switzerland
• PMID: 22378466 (Publication Type: Journal Article)
• Copyright: Copyright © 2012 S. Karger AG, Basel.

Topics

• Adolescent
• Adult
• Aged
• Chi-Square Distribution
• China
• Endoscopes (adverse effects)
• Equipment Design
• Female
• Humans
• Hydronephrosis (etiology)
• Kidney Calculi (complications, diagnostic imaging, surgery, urine)
• Leukocyte Count
• Male
• Middle Aged
• Nephrostomy, Percutaneous (adverse effects, instrumentation)
• Postoperative Hemorrhage (etiology, therapy)
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Severity of Illness Index
• Shock, Septic (etiology, therapy)
• Time Factors
• Ultrasonography, Interventional
• Urine (cytology)
• Young Adult