Lithotrites and postoperative fever: 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).


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.
Comprehensive Kidney Stone Center, Duke University Medical Center, Durham, N.C., USA.
David I
DI
Chu
Michael E
ME
Lipkin
Agnes J
AJ
Wang
Michael N
MN
Ferrandino
Glenn M
GM
Preminger
Kittinut
K
Kijvikai
Narmada P
NP
Gupta
Michael D
MD
Melekos
Jean J M C H
JJ
de la Rosette
D000328:Adult; D019072:Antibiotic Prophylaxis; D015331:Cohort Studies; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007391:International Cooperation; D007669:Kidney Calculi / Q000601:surgery*; D008096:Lithotripsy / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D012042:Registries; D012044:Regression Analysis; D012306:Risk