Objective: To compare the risks of fever from different lithotrites after percutaneous nephrolithotomy (PNL). Materials and Methods: The Clinical Research Office of the Endourological Society (CROES) PNL database is a prospective, multi-institutional, international PNL registry. Of 5,803 total patients, 4,968 received preoperative antibiotics, were supplied with complete information and included in this analysis. The lithotrites assessed included no fragmentation, ultrasonic, laser, pneumatic and combination ultrasonic/pneumatic. Risk of fever was estimated using multivariate logistic regression with adjustment for diabetes, steroid use, a history of positive urine culture, the presence of staghorn calculi or preoperative nephrostomy, stone burden and lithotrite. Results: The overall fever rate was 10%. Pneumatic lithotrites were used in 43% of the cohort, followed by ultrasonic (24%), combination ultrasonic/pneumatic (17.3%), no fragmentation (8.4%) and laser (7.3%). Fever rates were no different between patients who underwent no or any fragmentation (p = 0.117), nor among patients when stratified by lithotrite (p = 0.429). On multivariate analysis, fragmentation was not significantly associated with fever [Odds Ratio (OR) 1.17, p = 0.413], while diabetes (OR 1.32, p = 0.048), positive urine culture (OR 2.08, p < 0.001), staghorn calculi (OR 1.80, p < 0.001) and nephrostomy (OR 1.65, p < 0.001) increased fever risk. Fever risk among lithotrites did not differ (p ≥ 0.128). Conclusions: Risk of post-PNL fever was not significantly different among the various lithotrites used in the CROES PNL study.

Keywords:
Percutaneous nephrolithotomy, Lithotrites, Fever
1.
Michel MS, Trojan L, Rassweiler JJ: Complications in percutaneous nephrolithotomy. Eur Urol 2007;51:899-906(disc 906).
2.
Gomez-Nunez JG, Alvarez UM, Fernandez F, et al: Interaction of intracorporeal lithotripters with Proteus mirabilis inoculated inside artificial calcium and struvite stones. J Endourol 2009;23:519-522.
3.
Gutierrez J, Alvarez UM, Mues E, et al: Inactivation of bacteria inoculated inside urinary stone-phantoms using intracorporeal lithotripters. Urol Res 2008;36:67-72.
4.
Prabakharan S, Teichman JM, Spore SS, et al: Proteus mirabilis viability after lithotripsy of struvite calculi. J Urol 1999;162:1666-1669.
5.
Auge BK, Lallas CD, Pietrow PK, et al: In vitro comparison of standard ultrasound and pneumatic lithotrites with a new combination intracorporeal lithotripsy device. Urology 2002;60:28-32.
6.
de la Rosette J, Assimos D, Desai M, et al: The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients. J Endourol 2011;25:11-17.
7.
Chen S, Zhu L, Yang S, et al: High- vs. low-power holmium laser lithotripsy: a prospective, randomized study in patients undergoing multitract minipercutaneous nephrolithotomy. Urology 2012;79:293-297.
8.
Lehman DS, Hruby GW, Phillips C, et al: Prospective randomized comparison of a combined ultrasonic and pneumatic lithotrite with a standard ultrasonic lithotrite for percutaneous nephrolithotomy. J Endourol 2008;22:285-289.
9.
O'Keeffe NK, Mortimer AJ, Sambrook PA, et al: Severe sepsis following percutaneous or endoscopic procedures for urinary tract stones. Br J Urol 1993;72:277-283.
10.
Cadeddu JA, Chen R, Bishoff J, et al: Clinical significance of fever after percutaneous nephrolithotomy. Urology 1998;52:48-50.
11.
Labate G, Modi P, Timoney A, et al: The Percutaneous Nephrolithotomy Global Study: classification of complications. J Endourol 2011;25:1275-1280.
12.
Dogan HS, Guliyev F, Cetinkaya YS, et al: Importance of microbiological evaluation in management of infectious complications following percutaneous nephrolithotomy. Int Urol Nephrol 2007;39:737-742.
13.
Gonen M, Turan H, Ozturk B, et al: Factors affecting fever following percutaneous nephrolithotomy: a prospective clinical study. J Endourol 2008;22:2135-2138.
14.
Korets R, Graversen JA, Kates M, et al: Post-percutaneous nephrolithotomy systemic inflammatory response: a prospective analysis of preoperative urine, renal pelvic urine and stone cultures. J Urol 2011;186:1899-1903.
© 2013 S. Karger AG, Basel
2013
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