Vacuum-assisted Mini-percutaneous Nephrolithotomy is Associated with Lower Rates of Infectious Complications Compared to Vacuum-cleaner Procedure in Patients at High Risk for Infections: a Single-center Experience

Overview

Journal World J Urol

Specialty Urology

Date 2024 Mar 27

PMID 38536503

Authors

Andrea Marmiroli

Marco Nizzardo

Stefano Paolo Zanetti

Gianpaolo Lucignani

Matteo Turetti

Carlo Silvani

Franco Gadda

Fabrizio Longo

Elisa De Lorenzis

Giancarlo Albo

Andrea Salonia

Emanuele Montanari

Luca Boeri

Affiliations

Soon will be listed here.

Abstract

Purpose: To evaluate the impact of vacuum-assisted mini-percutaneous nephrolithotomy (vamPCNL) vs. vacuum-cleaner mPCNL (vcmPCNL) on the rate of postoperative infectious complications in a cohort of patients with high risk factors for infections.

Methods: We retrospectively analysed data from 145 patients who underwent mPCNL between 01/2016 and 12/2022. Patient's demographics, stones characteristics and operative data were collected. vamPCNL and vcmPCNL were performed based on the surgeon's preference. High-risk patients were defied as having ≥ 2 predisposing factors for infections such as a history of previous urinary tract infections, positive urine culture before surgery, stone diameter ≥ 3 cm, diabetes mellitus and hydronephrosis. Complications were graded according to modified Clavien classification. Descriptive statistics and logistic regression models were used to identify factors associated with postoperative infectious complications.

Results: vamPCNL and vcmPCNL were performed in 94 (64.8%) and 51 (35.2%) cases, respectively. After surgery, infectious complications occurred in 43 (29.7%) participants. Patients who developed infectious complications had larger stone volume (p = 0.02) and higher rate of multiple stones (p = 0.01) than those who did not. Infectious complications occurred more frequently after vcmPCNL than vamPCNL (55.9% vs. 44.1%. p = 0.01) in high-risk patients. Longer operative time (p < 0.01) and length of stay (p < 0.01) were observed in cases with infectious complications. At multivariable logistic regression analysis, longer operative time (OR 1.1, p = 0.02) and vcmPCNL (OR 3.1, p = 0.03) procedures were independently associated with the risk of infectious complications post mPCNL, after accounting for stone volume.

Conclusion: One out of three high-risk patients showed infectious complications after mPCNL. vamPCL and shorter operative time were independent protective factors for infections after surgery.

Citing Articles

Safety and efficacy of vacuum-assisted mini-percutaneous nephrolithotomy for the treatment of renal stone disease: an analysis of stone free status and postoperative infectious complications.

Kolanukuduru K, Zaytoun O, Tillu N, Mandel A, Dovey Z, Buscarini M Int Braz J Urol. 2024; 50(6):737-745.

PMID: 39133794 PMC: 11554283. DOI: 10.1590/S1677-5538.IBJU.2024.0308.

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