| Objective:To investigate the correlation of preoperative midstream urine,interoperate pelvic urine and the cultural results of bacterial stones of PCNL and postoperative systemic inflammatory response syndrome (SIRS).Methods: 138 patients who underwent percutaneous lithotripsy when they were hospitalized in the urology of affiliated hospital of Hebei University during July 2009 to November 2010 were chosen. 50patients'routine urinalysis showed the presence of urinary tract infection,88 non-infected patients were made the control group. Midstream urine was cultured preoperatively and sensitivity was tested to the patients whose white blood cell count of routine urinalysis was higher than nomal, and then the routine urinalysis were controlled to normality through the application of sensitive antibiotics. Pelvic urine was kept intraoperatively for bacterial culture and sensitivity was tested, stones were pestled immediately for bacterial culture and sensitivity was tested after the stones were removed. After the operation, such relevant indicators with the SIRS as the patients'temperature, heart rate, breathing, number of white blood cell in blood and urine etc. were monitored, and the incidence of postoperative SIRS of the two group was compared.Results: In all the 138 patients, 30(21.7%) had positive midstream urine before the operation (bacterial colony count>100000) before the operation, 25(18.1%) had positive pelvic urine during the operation, 42(30.4%) had positive stone culture. Escherichia were the predominant bacteria, followed by candida albicans and serratia. The bacterial culture result of midstream urine was not completely different from that of pelvic urine, and so was pelvic urine and stones. The positive rate of midstream urine cultural results of the patients with infection stones and with non-infection stones, had not statistically obvious difference(P>0.05). The positive rate of pelvic urine cultural results of the patients with infection stones was obviously higher than that of the ones with non-infection stones, the difference was statistically significant(P<0.01). The positive rate of pelvic urine cultural results of the patients with moderate or severe hydronephrosis was higher than that of the ones with mild or no hydronephrosis, the difference was statistically significant(P<0.05). Stones'properties were closely related to the results of bacterial culture, and were also related to the size, surface roughness,texture and transmittance of stones. SIRS occurred within 24 hours after surgery, ofwhich 9 cases (18.0%) occurred in 50 cases of preoperative urinary tract infection group, 6 cases (6.8%) occurred in 88 cases of control group. The rate of SIRS in the patients with urinary tract infection preoperatively and in those without urinary tract infection postopertatively was obviously different, and the difference was statistically significant (P <0.05). In the patients who had SIRS after PCNL, 2 (0.014%) of them had positive blood culture.Conclusions: 40% patients with upper urinary calculi had urinary tract infection, and urinary tract infection can be diagnosed by the way of culturing midstream urine preoperatively, keeping pelvic urine intraoperatively and culturing stones postoperatively. Escherichia were the predominant bacteria. The degree of hydronephrosis is proportional to the positive rate of bacterial culture. The rate of postopertative SIRS in the patients with urinary tract infection and in those without urinary tract was different. The rate of postoperative SIRS in the patients with urinary tract infection was higher than that in the patients without urinary tract infection. Postoperative SIRS might happen in the patients without urinary tract infection. The bacterial culture results of preoperative midstream urine can not effectively reflect that of pelvic urine and stones. Sensitive antibiotics should be chosen postoperatively according to the results of bacterial culture of pelvic urine and stones. |
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