陳柏仲、周詠欽、沈正煌、鄭明進、林昌德、陳丕哲、賴韋宏

嘉義基督教醫院 外科部 泌尿科

Bo-Jung Chen, Yeong-Chin Jou, Cheng-Huang Shen, Ming-Chin Cheng, Chang-Te Lin, Pi-Che Chen, Wei-hong Lai

Department of Urology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan

Purpose: According to 2016 EAU guideline on urolithiasis “Potential persistent bacteriuria due to infected stones” was suggested to be a contraindications for a tubeless percutaneous nephrolithotomy (PCNL). The aim of this study is to clarify the safety in performing tubeless PCNL in patients with potential infected stone.

Materials and Methods: Since January 2011 to June 2016, 425 tubeless PCNL was performed at our hospital. All patients received one stage procedure with metal dilator. Prophylatic antibiotic with cefazoline or according to preoperative urine culture was given to every patients. After the end of stone extraction, the access tract was cauterized and an 8 Fr or 10 Fr Foley catheter was inserted to the renal pelvis through the working sheath then inflated and gently retracted. The working sheath was withdrawn to the renal capsule and the access tract of the renal parenchyma was packed with Surgicele and compressed with small sized dilators through the working sheath for 5 minutes. A bloodless tract usually could be obtained in nearly every patient and all patients underwent tubeless modification. The results of these patients were analyzed with retrospective chart review and software SPSS V.21.

Results: Of the 425 patients, 285 patients were male and 140 patients were female. The age of these 247 patients ranged from 22 to 86 (mean 54.49±11.57) years old. The characteristics of the stone were staghorn stone in 80 patients (18.8%), renal stone in 198 patients (46.6%), ureteral stone in 99 patients (23.3%) and kidney with ureteral stone in 48 patients (11.3%). The pre-operative pyuria group and pre-operative non-pyuria group had no significant in post-operative complications, such as post-operative fever (8.99% vs 2.32%, p=0.104), blood transfusion rate (2.64% vs 0%, p=0.336), sepsis rate (15.8% vs 0%, p=0.522). The pre-operative positive urine culture has increasing risk of post-operative fever comparing to pre-operative negative urine culture (12.6% vs 6.07%, p=0.018), but no significant in blood transfusion rate (3.52% vs 1.78%, p=0.217) and sepsis rate (2.81% vs 0.71%, p=0.102). Positive stone culture increases the risks of post-operative fever (20.2% vs 4.73%, p=0.000), blood transfusion rate (6.06% vs 1.26%, p=0.020), sepsis (4.04% vs 0.63%, p=0.040) and hospital stay (3.62±7.183 vs 2.92±1.139, p=0.005). The stone culture is the most significant risk related to post-operative complications. However, most cases are lack of available data of pre-operative stone culture and all of these patients recovered well after optimal medical treatment

Conclusions: Tubeless PCNL is a safe modality in treating patients with potential infected stones.