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

• Published in: World journal of urology 2024-03, Vol.42 (1), p.200-200, Article 200
• Main Authors: Marmiroli, Andrea, Nizzardo, Marco, Zanetti, Stefano Paolo, Lucignani, Gianpaolo, Turetti, Matteo, Silvani, Carlo, Gadda, Franco, Longo, Fabrizio, De Lorenzis, Elisa, Albo, Giancarlo, Salonia, Andrea, Montanari, Emanuele, Boeri, Luca
• Format: Article
• Language: English
• Subjects: Diabetes mellitus; Humans; Infections; Kidney Calculi - complications; Medicine; Medicine & Public Health; Nephrolithotomy, Percutaneous - adverse effects; Nephrolithotomy, Percutaneous - methods; Nephrology; Oncology; Original; Original Article; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Regression analysis; Retrospective Studies; Risk factors; Risk groups; Statistical analysis; Surgery; Treatment Outcome; Urinary tract; Urinary Tract Infections - complications; Urinary Tract Infections - etiology; Urological surgery; Urology; Vacuum
• ISSN: 1433-8726; 0724-4983; 1433-8726
• DOI: 10.1007/s00345-024-04897-3

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