Prediction of systemic inflammatory response syndrome and urosepsis after percutaneous nephrolithotomy by urine culture, stone culture, and renal pelvis urine culture: Systematic review and meta-analysis

BackgroundPercutaneous nephrolithotomy (PCNL) is thought to have an increased risk of infectious complications. This study evaluates the predictability of preoperative midstream urine culture (PMUC), stone culture (SC), and renal pelvis urine culture (RPUC) for post-PCNL systemic inflammatory response syndrome (SIRS) or urosepsis.MethodAfter literature search in electronic databases (Embase, PubMed, Ovid, Science Direct, and Springer), studies were selected by following precise eligibility criteria. The quality of included studies was assessed, and meta-analyses of proportions were performed to seek culture positivity rates and incidence rates of post-PCNL SIRS/urosepsis. Meta-analyses of odds ratios (OR) were performed to evaluate the odds of positivity between SC and PMUC or RPUC, and the odds of post-PCNL SIRS/urosepsis with SC versus PMUC or RPUC.ResultsNineteen studies (4829 patients) were included. Positivity rates of PMUC, SC, and RPUC were 16% 95% CI: 12, 20, 21% 95% CI: 16, 26 and 10% 95% CI: 7, 14 respectively. The odds of positivity were significantly higher for SC compared to PMUC (OR 1.37 95%CI: 1.02, 1.84; p=0.037) or RPUC (OR 1.65 95%CI: 1.25, 2.18 p<0.0001). The incidence of post-PCNL SIRS and urosepsis was 21% 95%CI: 17, 25 and 6% 95%CI: 3, 10 respectively. The odds of post-PCNL SIRS were significantly higher with SC compared to PMUC (OR 2.45 95%CI: 1.12, 5.38 p=0.025) or RPUC (OR 2.10 95%CI: 1.33, 3.30; p=0.001) positivity. The odds of developing urosepsis after PCNL were not significantly different between SC and PMUC positivity (OR 1.874 95% CI: 0.943, 3.723; p=0.073).ConclusionThe risk of post-PCNL SIRS is found higher with SC than with PMUC or RPUC positivity. However, the risk of urosepsis may not be different between SC and PMUC.