J Urol
Department of Urology and Division of Biomedical Statistics and Informatics (EJB), Mayo Clinic, Rochester, Minnesota. Electronic address:
Published: December 2014
Purpose: Despite global concern about antibiotic related complications the duration of antibiotic therapy at percutaneous nephrolithotomy varies based on individual physician practice. We evaluated perioperative antibiotic related complications in patients who received extended antimicrobial therapy at percutaneous nephrolithotomy.
Materials And Methods: We reviewed the records of 227 consecutive patients treated with percutaneous nephrolithotomy from 2009 to 2013. Patients with positive urine or stone cultures received extended antimicrobial treatment. All others received 7 days of empirical therapy preoperatively and postoperatively. Adverse antibiotic related events were recorded for up to 3 months.
Results: The median duration of antibiotic therapy was 14 days (IQR 14-34). Perioperatively 143 (63%), 67 (30%), 75 (33%) and 41 patients (18%) received nitrofurantoin, trimethoprim/sulfamethoxazole, fluoroquinolones and other antibiotics, respectively. Antibiotic related complications developed in 23 patients (10%) at a median of 12 days (IQR 8-19). Common complications included rash in 7 cases (3%), gastrointestinal upset in 6 (3%) and Clostridium difficile colitis in 1 (0.4%). Trimethoprim/sulfamethoxazole was associated with an increased likelihood of an adverse event (p = 0.04) but patient age, gender, and therapy type (therapeutic vs prophylactic) and duration were not. Finally, antibiotic and multidrug resistance developed in 4 (36%) and 3 patients (27%), respectively, who experienced a urinary tract infection.
Conclusions: We report a low rate of adverse antibiotic related events in patients treated with percutaneous nephrolithotomy who received extended perioperative antibiotic therapy. Exposure to trimethoprim/sulfamethoxazole was the only identifiable risk factor for a complication. These findings should be considered when counseling patients on the risks of perioperative antimicrobial therapy at percutaneous nephrolithotomy.
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http://dx.doi.org/10.1016/j.juro.2014.06.090 | DOI Listing |
Nat Rev Urol
January 2025
Department of Urology, Lenox Hill Hospital/Northwell Health, New York, NY, USA.
Pain related to percutaneous nephrolithotomy (PCNL) is multifactorial and poorly elucidated. However, understanding the pathophysiology of pain can enable a practical approach to pain management, which can be tailored to each patient. A number of potential mechanisms underlie pain perception in PCNL, and these mechanisms can be leveraged at various points on the perioperative care pathway.
View Article and Find Full Text PDFMinerva Urol Nephrol
January 2025
Department of Urology, ASST Lariana, Como, Italy.
Cureus
December 2024
Department of Cardiovascular Medicine, Khyber Medical Institute of Medical Sciences, Kohat, PAK.
Background: Percutaneous nephrolithotomy (PCNL) is the preferred treatment for large renal stones, yet variability in outcomes arises from patient-specific factors and institutional practices. Understanding complications and predictors of success is essential to improving procedural efficacy.
Objective: This study aimed to evaluate stone clearance rates, complications classified using the Clavien-Dindo system, and predictors of PCNL outcomes, with a focus on improving lower calyx stone clearance.
Surg Innov
January 2025
Department of Urology, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China.
Backgroud: Perirenal hematoma (PRH) is a notable complication following percutaneous nephrolithotomy (PCNL) with significant implications for patient outcomes. This study aimed to develop a nomogram predictive model for PRH after PCNL.
Methods: Retrospective data from patients who underwent PCNL were analyzed.
Urolithiasis is a multifactorial condition where stone composition is critical in guiding treatment and prevention strategies. Advanced diagnostic techniques, such as infrared spectroscopy, provide precise stone analysis, enabling clinicians to tailor interventions based on specific stone types and associated metabolic abnormalities. Calcium oxalate monohydrate stones often require invasive approaches like percutaneous nephrolithotomy, while uric acid responds well to dissolution therapy.
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