Management of infectious complications in percutaneous nephrolithotomy.
Infectious complications are one of the most frequent and feared adverse medical events in percutaneous nephrolithotomy. They represent a dangerous and life-threatening condition, especially when postoperative septicemia or severe sepsis develops. In order to limit morbidity and mortality it is crucial to recognize preoperative and intraoperative risk factors that could be clear contributors to an adverse infectious event; those factors are mainly immunosuppression caused by some comorbidities, presence of urinary infection or colonization, stone characteristics, obstruction, long-lasting operation, and high intrapelvic pressure during nephrolithotomy. Close observation during the immediate and early postoperative period must be established and a high index of suspicion must be maintained to identify a major complication. The early recognition and prompt multidisciplinary management of sepsis is mandatory to optimize the final outcome. Appropriate therapy is a continuum of management of infection, ranging from adequate drainage and broad-spectrum antibiotics to aggressive fluid resuscitation and invasive monitoring with medical management in the intensive care setting until the causative agent is found and eradicated.
Nuevo Hospital Civil de Guadalajara, Universidad de Guadalajara and Instituto de Endourologia , Hospital Puerta de Hierro, Zapopan, Mexico .
Oscar
O
Negrete-Pulido
Jorge
J
Gutierrez-Aceves
D000465:Algorithms; D001424:Bacterial Infections / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D007430:Intraoperative Care; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects*; D012307:Risk Factors