title: Post-percutaneous nephrolithotomy septic shock and severe hemorrhage: a study of risk factors.
abstract: OBJECTIVE
  To identify the risk factors predicting septic shock and severe hemorrhage in percutaneous nephrolithotomy (PCNL).
  
  
  METHODS
  We retrospectively analyzed 420 renal calculi patients who underwent ultrasound-guided PCNL from March 2005 to May 2011. Data on patients who experienced infectious shock requiring anti-shock therapy and severe renal bleeding requiring angiographic renal embolization or nephrectomy were compared with other patients using univariate analyses.
  
  
  RESULTS
  Of 420 patients, 10 (2.4%) suffered septic shock and 4 (1%) had severe hemorrhage. The two significant risk factors for infectious shock were preoperative urine white blood cell count and operation time. For severe bleeding the absence of hydronephrosis and puncture time were significant risk factors. Operation time >90 min was associated with both septic shock and severe renal bleeding (p = 0.017). In contrast, the risk of encountering severe renal bleeding was higher if a nephroscope rather than a ureteroscope was used (p = 0.045).
  
  
  CONCLUSIONS
  Operation time was a risk factor for both septic shock and severe hemorrhage. The patients without hydronephrosis before operation were more likely to suffer severe renal bleeding. Reducing intraoperative puncture time can reduce the probability of severe post-PCNL hemorrhage. The use of a comparatively gross nephroscope passage was likely to result in severe renal bleeding.
authors.affiliation: Department of Urology, First Hospital of Jilin University, Changchun, People's Republic of China.
authors.forename: Yanbo
authors.initials: Y
authors.lastname: Wang
authors.forename: Fengming
authors.initials: F
authors.lastname: Jiang
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.forename: Yuchuan
authors.initials: Y
authors.lastname: Hou
authors.forename: Haifeng
authors.initials: H
authors.lastname: Zhang
authors.forename: Qihui
authors.initials: Q
authors.lastname: Chen
authors.forename: Ning
authors.initials: N
authors.lastname: Xu
authors.forename: Zhihua
authors.initials: Z
authors.lastname: Lu
authors.forename: Jinghai
authors.initials: J
authors.lastname: Hu
authors.forename: Ji
authors.initials: J
authors.lastname: Lu
authors.forename: Xiaoqing
authors.initials: X
authors.lastname: Wang
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Hao
authors.forename: Chunxi
authors.initials: C
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D002681:China; D019723:Endoscopes / Q000009:adverse effects; D004867:Equipment Design; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology; D007669:Kidney Calculi / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery* / Q000652:urine; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects* / Q000295:instrumentation; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000209:etiology* / Q000628:therapy; D013997:Time Factors; D018084:Ultrasonography, Interventional; D014556:Urine / Q000166:cytology; D055815:Young Adult