Factors Related To Postoperative Febrile Urinary Tract Infection Following MPCNL In Prepubertal Children

Objective: To explore the factors contributing to postoperative febrile urinary tract infection(FUTI)following minimally invasive percutaneous nephrolithotomy(MPCNL)in prepubertal children and to study its prevention measures.Methods: The clinical data of 360 prepubertal children with upper urinary calculi underwent MPCNL in our hospital from January 2015 to August 2018 were retrospectively reviewed.Medical recordings including age and age categories,gender,previous ipsilateral renal surgery,kidney abnormalities,preoperative urine culture,urinary white blood cell count,hydronephrosis and pyonephrosis,presence of upper ureteral calculi,preoperative Serum creatinine values,stone size,stone type(whether infective stones),staghorn calculus,PCNL side,tract location,number of tract,tract size,operative time,blood transfusion,intraoperative complications(SATAVA Classification),postoperative tubeless,stones status,etc.According to whether developed FUTI after surgery,the patients were divided into two groups.Univariate analysis was performded for each factors.Factors found to be significantly different that were further analyzed using binary multivariate logistic regression analysis.Results: The MPCNL procedure of the 360 cases were performed successfully,and there were 33(9.2%)patients that occurred FUTI after surgery.In univariate analysis showes gender,age and age categories,preoperative urine culture,preoperative urinary white blood cell count ?10/HP,preoperative pyonephrosis,combined with upper ureteral calculi,stone size > 2cm,infectious stones,staghorn stones,PCNL side,number of tract,tract size,operation time ?90min,blood transfusion,intraoperative complications(SATAVA classification)between the two groups,the differences that were statistically significant(P<0.05).Logistic multivariate analysis showed that infants,females,stone size > 2cm,infectious stones,staghorn stones,smaller tract size,operation time ?90 min,and blood transfusion were independent risk factors of FUTI after operation(OR>1,P<0.05).Conclusions: Infants,females,stone size,infectious stones,staghorn stones,smaller tract size,longer operation time,and blood transfusion are identified as independent risk factors to development of postoperative FUTI in prepubertal children.Special precautions and monitoring should be taken in younger children with bigger stone and with severe intraoperative hemorrhage requiring blood transfusion.It is better to stage the procedure rather than prolong the operative time.Analysis of the stone composition is critical to elucidating the underlying etiology and management.Identifying these factors and minimizing them may decrease the incidence of life threatening complication.