Etemadian Masoud, Haghighi Ramin, Madineay Ali, Tizeno Adel, Fereshtehnejad Seyed Mohammad
Department of Endourology, Shaheed Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran.
Urol J. 2008 Winter;5(1):28-33.
We present our experience in continuing percutaneous nephrolithotomy (PCNL) versus delayed PCNL when purulent fluid is aspirated during access to the pyelocaliceal system.
This randomized controlled study was carried out on patients who had purulent urine in the pyelocaliceal system at the initial puncturing during PCNL. Patients with recent untreated urinary tract infection, thick or foul pus in aspirated urine, fever, and immunocompromised condition were excluded. Thirty-one patients were randomly divided into 2 groups. In group 1, PCNL was continued, but in group 2, nephrostomy tube was placed and PCNL was performed 10 days later after documented sterile nephrostomy urine. The preoperative and postoperative findings were compared.
There were 16 and 15 patients in groups 1 and 2, respectively. All patients had negative urine cultures for microorganisms, preoperatively. The purulent aspirated fluid was infected in 43.8% and 40.0% of the patients in groups 1 and 2, respectively. Postoperative fever was seen in 25.0% and 26.7% of the patients, respectively. No statistical differences were observed between the two groups in terms of bacteriuria, bacteremia, positive calculus cultures, or stone-free rates, and duration of hospitalization between groups 1 and 2, respectively. More analysis with linear regression model showed that postoperative positive blood culture (P < .001), fever (P = .001), and postoperative positive urine culture (P = .02) correlated with duration of hospitalization.
In the absence of untreated recent UTI and aspiration of thick or foul pus, continuing PCNL can be safe while purulent urine is encountered.
我们介绍了在经皮肾镜取石术（PCNL）过程中，当肾盂肾盏系统穿刺抽出脓性液体时，继续进行PCNL与延迟PCNL的经验。
本随机对照研究针对PCNL初始穿刺时肾盂肾盏系统有脓性尿液的患者开展。排除近期未治疗的尿路感染、抽出尿液中脓液浓稠或有异味、发热及免疫功能低下的患者。31例患者随机分为2组。第1组继续进行PCNL，而第2组放置肾造瘘管，在肾造瘘尿液无菌记录后10天进行PCNL。比较术前和术后结果。
第1组和第2组分别有16例和15例患者。所有患者术前尿液微生物培养均为阴性。第1组和第2组分别有43.8%和40.0%的患者抽出的脓性液体被感染。术后发热分别见于25.0%和26.7%的患者。两组在菌尿、菌血症、结石培养阳性或结石清除率以及住院时间方面均未观察到统计学差异。线性回归模型的更多分析表明，术后血培养阳性（P <.001）、发热（P =.001）和术后尿培养阳性（P =.02）与住院时间相关。
在近期无未治疗的尿路感染且未抽出浓稠或有异味的脓液的情况下，遇到脓性尿液时继续进行PCNL可能是安全的。
