Risk factors of fevers and prophylaxis policy after percutaneous nephrostolithotomy

Objective To analyze the risk factors of fevers after percutaneous nephrostolithotomy (PCNL) and to determine a more effective prophylaxis method.Methods A retrospective analysis of 320cases who underwent PCNL for renal calculi from 2008 to 2011 (men 233,women 87,age between 22 years to 72 years) was made.The average age of the patients and the average diameter of the stones were 42 years and 3cm(0.8 -6 cm),respectively.We analyzed factors such as age ( ＞60 years and ≤60 years),stone size ( ＞2.0 cm and ≤2.0 cm),operative time ( ＞60 min and ≤60 min),irrigation pump pressure ( ＞120 mm Hg and ≤ 120 mm Hg),obstructive conditions,preoperative urinary tract infection and fever.Wethen compared the fever rate with each of the risk factors.Results There were 59 cases with fever after PCNL; 18.4％ of the cases had a temperature over 38 ℃.There were two cases of pyemia.The patients whose stone diameter ＞ 2 cm had a post-operative fever rate of 22.4％.The fever rate in patients whose stone diameter ≤2.0 cm was 10.4％.The fever rate in patients with an operative time ＞60 min and ≤60 min was 27.2％ and 10.4％,respectively.Patients with irrigation pump pressure ＞ 120 mm Hg and ≤ 120mm Hg had post-operative fever rates of 28.3％ and 11.0％,respectively.There was statistical significance between each post-operative fever risk factor group.Conclusions The post PCNL fever risk factors are stone diameter ＞ 2.0 cm,operation time ≤60 min and irrigation pump pressure ＞ 120 mm Hg.The effective prophylaxis policy of post-operative fever are the pre-operative using of broad-spectrum antibacterial agents,shorter operative time and lower irrigation pump pressure.A two-stage operation procedure will also reduce the post-operative fever. Key words: Percutaneous nephrostolithotomy ;  Renal calculus ;  Fever