CU 22. Post - percutaneous nephrolithotomy septic shock and severe hemorrhage: A study of risk factors

Objective: To identify the risk factors predicating septic shock and severe hemorrhage due to percutaneous nephrolithotomy (PCNL).

Methods: The clinical data of 420 renal calculi patients who underwent ultrasound-guided percutaneous nephroscopy/ ureteroscope holmium laser lithotripsy from March 2004 to May 2010 in the First Hospital of Jilin University were retrospectively reviewed. The pre-hospitalization urine white cell count, stone position, kidney morphology, calculus diameter, puncture times, operation time, and operation method were recorded.

Results: Of these 420 patients, 10 (2.4%) experienced septic shock and 4 (1%) experienced severe hemorrhage. Significant risk factors for infectious shock were urine white cell count (WBC) before hospitalization and operation time. Significant risk factors for severe bleeding were kidney morphology and puncture times. In coherent with septic shock, the patients with operation time more than 90 minutes were more susceptible to severe renal bleeding (P=0.017). In conflicting with septic shock, the risk of severe renal bleeding for patients by nephroscopy was higher than those by ureteroscopy (P=0.045).

Conclusions: Operation time was a risk factor for both septic shock and severe hemorrhage of PCNL. Proper pre-operation anti-inflammatory therapy can reduce the incidence of septic shock after PCNL. Patients with no-hydronephrosis in preoperation are more susceptible to severe renal bleeding. Reducing the intra-operational puncture time may lower the possibility of post-PCNL extensive hemorrhage.