Vacuum-assisted mini-percutaneous nephrolithotomy is associated with lower rates of infectious complications compared to vacuum-cleaner procedure in patients at high risk for infections: a single-center experience

Andrea Marmiroli; Marco Nizzardo; Stefano Paolo Zanetti; Gianpaolo Lucignani; Matteo Turetti; Carlo Silvani; Franco Gadda; Fabrizio Longo; Elisa De Lorenzis; Giancarlo Albo; Andrea Salonia; Emanuele Montanari; Luca Boeri

doi:10.1007/s00345-024-04897-3

Vacuum-assisted mini-percutaneous nephrolithotomy is associated with lower rates of infectious complications compared to vacuum-cleaner procedure in patients at high risk for infections: a single-center experience

World J Urol. 2024 Mar 27;42(1):200. doi: 10.1007/s00345-024-04897-3.

Authors

Affiliations

¹ Department of Urology, Fondazione IRCCS Ca' GrandaOspedale Maggiore Policlinico, Milan, Italy.
² Department of Urology, Fondazione IRCCS Ca' GrandaOspedale Maggiore Policlinico, Milan, Italy. albo.giancarlo@gmail.com.
³ Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy. albo.giancarlo@gmail.com.
⁴ Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy.
⁵ Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.

Abstract

Purpose: To evaluate the impact of vacuum-assisted mini-percutaneous nephrolithotomy (vamPCNL) vs. vacuum-cleaner mPCNL (vcmPCNL) on the rate of postoperative infectious complications in a cohort of patients with high risk factors for infections.

Methods: We retrospectively analysed data from 145 patients who underwent mPCNL between 01/2016 and 12/2022. Patient's demographics, stones characteristics and operative data were collected. vamPCNL and vcmPCNL were performed based on the surgeon's preference. High-risk patients were defied as having ≥ 2 predisposing factors for infections such as a history of previous urinary tract infections, positive urine culture before surgery, stone diameter ≥ 3 cm, diabetes mellitus and hydronephrosis. Complications were graded according to modified Clavien classification. Descriptive statistics and logistic regression models were used to identify factors associated with postoperative infectious complications.

Results: vamPCNL and vcmPCNL were performed in 94 (64.8%) and 51 (35.2%) cases, respectively. After surgery, infectious complications occurred in 43 (29.7%) participants. Patients who developed infectious complications had larger stone volume (p = 0.02) and higher rate of multiple stones (p = 0.01) than those who did not. Infectious complications occurred more frequently after vcmPCNL than vamPCNL (55.9% vs. 44.1%. p = 0.01) in high-risk patients. Longer operative time (p < 0.01) and length of stay (p < 0.01) were observed in cases with infectious complications. At multivariable logistic regression analysis, longer operative time (OR 1.1, p = 0.02) and vcmPCNL (OR 3.1, p = 0.03) procedures were independently associated with the risk of infectious complications post mPCNL, after accounting for stone volume.

Conclusion: One out of three high-risk patients showed infectious complications after mPCNL. vamPCL and shorter operative time were independent protective factors for infections after surgery.

Keywords: Aspiration; Infectious complications; Percutaneous nephrolithotomy; Safety; Stone.

MeSH terms

Humans
Kidney Calculi* / complications
Nephrolithotomy, Percutaneous* / adverse effects
Nephrolithotomy, Percutaneous* / methods
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Retrospective Studies
Treatment Outcome
Urinary Tract Infections* / complications
Urinary Tract Infections* / etiology