Research Of Sepsis Following Endoscopic Treatment Of Urinary Stones

ObjectiveCurrently the majority of upper urinary tract calculi is treated by percutaneous nephrolithotomy surgery(PCNL) or Ureteroscopy(URS) surgery. Compared with traditional open surgery, endourological surgery has less trauma, quicker recovery, clear vision, etc., but endovascular surgery postoperative urinary-derived sepsis is not uncommon. Serniak et al.reported that urinary-derived sepsis caused by urolithiasis is about 43%, the mortality rate can be as high as 20% to 40%. We can provide some clinical evidence for prevention of postoperative sepsis and antibiotic treatment by analysis of postoperative sepsis morbidity and related antibiotics of our treatment of urinary tract stones by endoscopic surgery. Methods441 cases of urinary calculi patients who was hospitalized in January 2010 to January 2013 were selected,in which 50 patients had postoperative sepsis. We analyze the differences of incidence of postoperative sepsis of two surgicals by statistical methods and the effect of gender and age have on postoperative sepsis. ResultsReceiving endovascular surgery of urinary calculi, 391 cases in 441 were not complicated by sepsis,the other 50 cases were complicated by sepsis,with the incidence rate of 12.36%. For people of different ages, the incidence of sepsis in patients with age greater than 65 and younger than 65 years have no obvious difference(х2=1.30,P>0.05); Incidence of men and women with no obvious difference(х2=1.20,P>0.05); The incidence of patients whose operating time is greater than 90 min and those whose Operating time is less than 90 min have obvious difference(х2=22.33,P<0.05);There is obvious difference in incedence in patients with ipsilateral urinary calculi surgery history and patients without ipsilateral urinary calculi surgery history(х2=11.30,P<0.05);Patients whose BMI greater than 30 and those whose BMI is less than 30 have obvious difference in incedence of sepsis(х2=64.06,P<0.05); The incidence of sepsis in patients with mean stone burden larger than 30 mm have obvious difference with patients with stone burden bellow 30mm(х2=6.37,P<0.05);There is no difference in incidence of sepsis between diabetes and non-diabetic patients(х2=0.03,P>0.05);Comparing PCNL and URS, male patients who received PCNL were more likely to have postoperation sepsis,and the result is statistical significant(х2=22.53,P<0.05);While the results have no statistical significance in women( х 2=3.08,P>0.05).According to result of blood culture, escherichia coli is common in female,while pseudomonas aeruginosa is common in male,and the bacteria caused female infection has more varities. ConclusionsThere is a high incidence of sepsis in patients with urinary calculi who received surgry of PCNL or URS, in which the incidence of sepsis in patients with age greater than 65 and younger than 65 years have no obvious difference. The incidence of patients whose operating time is greater than 90 min and those whose Operating time is less than 90 min have obvious difference. There is obvious difference in incedence in patients with ipsilateral urinary calculi surgery history and patients without ipsilateral urinary calculi surgery history. Patients whose BMI greater than 30 and those whose BMI is less than 30 have obvious difference in incedence of sepsis; The incidence of sepsis in patients with mean stone burden larger than 30 mm have obvious difference with patients with stone burden bellow 30mm;There is no difference in incidence of sepsis between diabetes and non-diabetic patients;Comparing the incidence of sepsis in males and females after PCNL and URS, we find that the incidence is different in males and the result is statistical significant,while females with difference is not obvious.This suggests that the trauma caused by PCNL may be greater than URS in male who received sugery with this two kinds of operation.