無管微創經皮腎臟碎石術後泌尿道感染之機率及影響因子

李亞哲、周詠欽、鄭明進、沈正煌、林昌德

嘉義基督教醫院 外科部 泌尿科

 Incidence and contributing factor for urinary tract infection post tubeless mini-percutaneous nephrolithotomy

Ya-Che Lee, Yeong-Chin Jou, Ming-Chin Cheng, Cheng-Huang Shen, Chang-Te Lin

Divisions of Urology, Department of Surgery, Chiayi Christian Hospital

Introduction: Percutaneous nephrolithotomy (PCNL) is commonly used in the management of large renal stones. Postoperative urinary tract infection (UTI) is one of the most common complications of this procedure. This research evaluated the frequency of UTI after tubeless mini-PCNL and the contributing factor.

Methods and Material: Between March 2017 and March 2019, 149(94 males and 55 females) tubeless mini-PCNLs were performed at our hospital. Patients had renal stone disease need operation with different body mass index and different type and size of stones were included in this study. Patients underwent bilateral procedures were excluded in this study. Renal stone sample were taken from all patients after tubeless mini-PCNL and send for bacterial culture and sensitivity test. Patients were monitored closely in the postoperative period for the development of urinary tract infection. The contributing factors for fever were evaluated by a retrospective chart review.

Results: The frequency of UTI after tubeless mini-PCNL was 11.4% (n=17). Of all patients, the mean age was 57.5 ± 11.3 years and the mean stone size was 2.92 ± 2.0 cm. There was no difference in gender (Male 52.9% versus 64.4%) (Female 47.1% versus 35.6%), age (59 ± 8 versus 57 ± 11), body mass index (26.3 ± 2.8 versus 25.3 ± 4.2) and overweight patients (BMI>27) in the development of UTI. There is no significant difference in the mean stone size (2.9 ± 1.8 versus 2.9 ± 2.0) or operation time (90.5 ± 39.2 versus 80.7 ± 24.4) or mean durations of hospitalization (3.6 ±1.9 versus 3.1 ±1.6) in UTI and non-UTI patients. Complete staghorn stones were noted in 17 patients, and their UTI rate (5.9%) was not significantly higher than patients with non-staghorn stone (11.5%). Patients with UTI after tubeless mini-PCNL had a high incidence of residual stones than the remaining patients (52.9% vs 6.06%, p=0.025). Diabetes mellitus (29.4% versus 19.7%), struvite stones (11.8% versus 2.3%) and the positive bacterial culture (29.4% versus 20.5%) were noted higher in the group with UTI, but they are not the statistically significant factors for UTI after tubeless mini-PCNL. In logistic regression model, post tubeless mini-PCNL UTI was associated with residual stone (OR = 3.12; p value=0.03).

Conclusions: We propose that incomplete stone extraction and struvite stones are major contributing factor to post tubeless mini-PCNL urinary tract infection.