Chu, David I4; Lipkin, Michael E5; Wang, Agnes J5; Ferrandino, Michael N5; Preminger, Glenn M5; Kijvikai, Kittinut5; Gupta, Narmada P5; Melekos, Michael D5; de la Rosette, Jean J M C H5; Osther, Palle Jørn Sloth6
1 Urological Department, Institute of Regional Health Research, Det Sundhedsvidenskabelige Fakultet, SDU2 Center Lillebaelt, Institute of Regional Health Research, Det Sundhedsvidenskabelige Fakultet, SDU3 Fredericia og Kolding Sygehus, Institute of Regional Health Research, Det Sundhedsvidenskabelige Fakultet, SDU4 Comprehensive Kidney Stone Center, Duke University Medical Center, Durham, N.C., USA.5 unknown6 Urological Department, Institute of Regional Health Research, Det Sundhedsvidenskabelige Fakultet, SDU
does lithotrite type matter? Results from the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study
OBJECTIVE: To compare the risks of fever from different lithotrites after percutaneous nephrolithotomy (PNL). MATERIALS AND METHODS: The Clinical Research Office of the Endourological Society (CROES) PNL database is a prospective, multi-institutional, international PNL registry. Of 5,803 total patients, 4,968 received preoperative antibiotics, were supplied with complete information and included in this analysis. The lithotrites assessed included no fragmentation, ultrasonic, laser, pneumatic and combination ultrasonic/pneumatic. Risk of fever was estimated using multivariate logistic regression with adjustment for diabetes, steroid use, a history of positive urine culture, the presence of staghorn calculi or preoperative nephrostomy, stone burden and lithotrite. RESULTS: The overall fever rate was 10%. Pneumatic lithotrites were used in 43% of the cohort, followed by ultrasonic (24%), combination ultrasonic/pneumatic (17.3%), no fragmentation (8.4%) and laser (7.3%). Fever rates were no different between patients who underwent no or any fragmentation (p = 0.117), nor among patients when stratified by lithotrite (p = 0.429). On multivariate analysis, fragmentation was not significantly associated with fever [Odds Ratio (OR) 1.17, p = 0.413], while diabetes (OR 1.32, p = 0.048), positive urine culture (OR 2.08, p < 0.001), staghorn calculi (OR 1.80, p < 0.001) and nephrostomy (OR 1.65, p < 0.001) increased fever risk. Fever risk among lithotrites did not differ (p ≥ 0.128). CONCLUSIONS: Risk of post-PNL fever was not significantly different among the various lithotrites used in the CROES PNL study.
Urologia Internationalis, 2013, Vol 91, Issue 3, p. 340-344