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Are Routine Laboratory Investigations Necessary Following Percutaneous Nephrolithotomy?

      Abstract

      OBJECTIVE

      To determine how effective routine postoperative blood work is in identifying complications after percutaneous nephrolithotomy (PCNL), the gold standard treatment for large volume stone disease. Although major complication rates are low, hemorrhagic and sepsis-related complications are serious and can occur. Routine post-PCNL complete blood count is routinely performed by most endourologists but may be a low-value practice.

      METHODS

      A retrospective review was performed of all PCNL procedures at our center over a 3-year period. Patient demographic, stone characteristics and postoperative data were collected and analyzed.

      RESULTS

      Three hundred and eighty-five patients (196 female and 189 males) underwent PCNL for the treatment of urolithiasis. Mean age was 55.8 years and mean length of stay in hospital was 1.74 days. Most patients (82.9%) had neither ureteric stent nor percutaneous tube prior to PCNL. Postoperatively, 4 patients (1.0%) required a blood transfusion and 14 patients (3.6%) developed urosepsis. Patients who required either a transfusion or developed urosepsis demonstrated abnormal vital signs (tachycardia, hypotension, or fever) postoperatively. Sixteen patients (4.2%) had normal vital signs but had an extended hospital stay only to monitor abnormal blood work results. None these patients required a transfusion nor developed urosepsis but had a length of stay that was a mean of 1.5 days longer patients with normal postoperative vital signs and blood work.

      CONCLUSION

      Abnormal vital signs alone identified all patients that required transfusion or treatment for urosepsis after PCNL. Routine complete blood count testing postoperatively may not improve detection of infectious or bleeding complications and may prolong hospital admission unnecessarily.
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      References

        • Fernstrom I
        • Johansson B
        Percutaneous pyelolithotomy. A new extraction technique.
        Scand J Urol Nephrol. 1976; 10: 257-259
        • Patel SR
        • Nakada SY
        The modern history and evolution of percutaneous nephrolithotomy.
        J Endourol. 2015; 29: 153-157
        • Jones P
        • Elmussareh M
        • Aboumarzouk OM
        • Mucksavage P
        • Somani BK
        Role of minimally invasive (micro and ultra-mini) PCNL for adult urinary stone disease in the modern era: evidence from a systematic review.
        Curr Urol Rep. 2018; 19: 27
        • Seitz C
        • Desai M
        • Hacker A
        • et al.
        Incidence, prevention, and management of complications following percutaneous nephrolitholapaxy.
        Eur Urol. 2012; 61: 146-158
        • de la Rosette J
        • Assimos D
        • Desai M
        • et al.
        The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients.
        J Endourol. 2011; 25: 11-17
        • Ghani KR
        • Andonian S
        • Bultitude M
        • et al.
        Percutaneous nephrolithotomy: update, trends, and future directions.
        Eur Urol. 2016; 70: 382-396
        • Bjazevic J
        • Nott L
        • Violette PD
        • et al.
        The evolution of percutaneous nephrolithotomy: analysis of a single institution experience over 25 years.
        Can Urol Assoc J. 2019; 13: E317-E324
        • El-Nahas AR
        • Shokeir AA
        • El-Assmy AM
        • et al.
        Post-percutaneous nephrolithotomy extensive hemorrhage: a study of risk factors.
        J Urol. 2007; 177: 576-579
        • Wang Y
        • Jiang F
        • Wang Y
        • et al.
        Post-percutaneous nephrolithotomy septic shock and severe hemorrhage: a study of risk factors.
        Urol Int. 2012; 88: 307-310
        • Bansal SS
        • Pawar PW
        • Sawant AS
        • Tamhankar AS
        • Patil SR
        • Kasat GV
        Predictive factors for fever and sepsis following percutaneous nephrolithotomy: review of 580 patients.
        Urol Ann. 2017; 9: 230-233
        • Draga RO
        • Kok ET
        • Sorel MR
        • Bosch RJ
        • Lock TM
        Percutaneous nephrolithotomy: factors associated with fever after the first postoperative day and systemic inflammatory response syndrome.
        J Endourol. 2009; 23: 921-927
        • Kreydin EI
        • Eisner BH
        Risk factors for sepsis after percutaneous renal stone surgery.
        Nat Rev Urol. 2013; 10: 598-605
        • Zhu W
        • Liu Y
        • Liu L
        • et al.
        Minimally invasive versus standard percutaneous nephrolithotomy: a meta-analysis.
        Urolithiasis. 2015; 43: 563-570
        • Beiko D
        • Lee L
        Outpatient tubeless percutaneous nephrolithotomy: the initial case series.
        Can Urol Assoc J. 2010; 4: E86-E90
        • Beiko D
        • Andonian S
        Getting started with ambulatory PCNL: a CanMEDS perspective.
        Can Urol Assoc J. 2015; 9: 223-225
        • Bechis SK
        • Han DS
        • Abbott JE
        • et al.
        Outpatient ercutaneous nephrolithotomy: the UC san diego health experience.
        J Endourol. 2018; 32: 394-401
        • Preminger GM
        • Clayman RV
        • Curry T
        • Redman HC
        • Peters PC
        Outpatient percutaneous nephrostolithotomy.
        J Urol. 1986; 136: 355-357
        • Cassel CK
        • Guest JA
        Choosing wisely: helping physicians and patients make smart decisions about their care.
        JAMA. 2012; 307: 1801-1802
        • Soucy F
        • Ko R
        • Duvdevani M
        • Nott L
        • Denstedt JD
        • Razvi H
        Percutaneous nephrolithotomy for staghorn calculi: a single center's experience over 15 years.
        J Endourol. 2009; 23: 1669-1673
        • Levinson W
        • Kallewaard M
        • Bhatia RS
        • et al.
        “Choosing wisely”: a growing international campaign.
        BMJ Qual Saf. 2015; 24: 167-174
      1. Five Things Physicians and Patients Should Question-AUA. 2015.http://www.choosingwisely.org/societies/american-urological-association. Accessed January 1, 2020

      2. Five Things Physicians and Patients Should Question-CUA. 2015.http://www.choosingwiselycanada.org/recommendations/urology/. Accessed January 1, 2020

        • Welk B
        • Winick-Ng J
        • McClure JA
        • Lorenzo AJ
        • Kulkarni G
        • Ordon M
        The impact of the choosing wisely campaign in urology.
        Urology. 2018; 116: 81-86
      3. Canadian institute for health information.
        Patient Cost Estimator. 2019; (Accessed December 15, 2019)
        • Jones P
        • Aboumarzouk OM
        • Zelhof B
        • Mokete M
        • Rai BP
        • Somani BK
        Percutaneous nephrolithotomy in patients with chronic kidney disease: efficacy and safety.
        Urology. 2017; 108: 1-6