Renal Intrapelvic Pressure During Percutaneous Nephrolithotomy and Its Correlation With the Development of Postoperative Fever

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Oct 2002Renal Intrapelvic Pressure During Percutaneous Nephrolithotomy and Its Correlation With the Development of Postoperative Fever Scott A. Troxel and Roger K. Low Scott A. TroxelScott A. Troxel and Roger K. LowRoger K. Low View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64446-1AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Systemic absorption of irrigation fluid containing bacteria or endotoxin may lead to fever and urosepsis after percutaneous nephrolithotomy. Although to our knowledge the exact method of absorption is undefined, intrapelvic pressure greater than 30 mm. Hg has been shown to result in pyelovenous-lymphatic backflow. We measured intrapelvic pressure during percutaneous nephrolithotomy and correlated pressure with postoperative fever and operative technique. Materials and Methods: Intrarenal pressure was measured with a transurethral 7Fr ureteral occlusion balloon catheter and a urodynamic system during percutaneous renal access, rigid and flexible nephroscopy, and intracorporeal lithotripsy. Postoperative fever was correlated with elevated intrarenal pressure, stone type and surgical technique. Results: Enrolled in this study were 18 women and 13 men. Pressure greater than 30 mm. Hg was recorded in 8 patients (26%). Elevated pressure occurred under 2 conditions, namely incomplete positioning of the nephroscopy sheath within the collecting system and endoscopy through a narrow infundibulum. In 13 cases (42%) a fever of 38C or greater developed postoperatively. Elevated pressure did not correlate with fever. However, of those undergoing percutaneous nephrolithotomy for the removal of infection versus noninfection stones 64% and 24%, respectively, had fever postoperatively. Conclusions: Renal intrapelvic pressure generally remains low during percutaneous nephrolithotomy. Elevated pressure was associated with incomplete nephroscopy sheath positioning within the collecting system and endoscopy through an infundibular narrowing. There was no association of renal pressure greater than 30 mm. Hg with fever but postoperative fever and percutaneous nephrolithotomy done for infection related stones correlated significantly. References 1 : Prediction of septicemia following endourologic manipulation of stones in the upper urinary tract. J Urol1991; 146: 955. Link, Google Scholar 2 : Severe sepsis following percutaneous or endoscopic procedures for urinary tract stones. Br J Urol1993; 72: 277. Google Scholar 3 : Pyelovenous lymphatic migration of transitional cell carcinoma following flexible ureterorenoscopy. J Urol1993; 149: 109. Link, Google Scholar 4 : Pyelovenous back flow. JAMA1926; 87: 1287. Google Scholar 5 : The hydrodynamics of renal irrigations: with reference to calculus solvents. J Urol1963; 89: 765. Link, Google Scholar 6 : Back-leak of pelvic urine to the bloodstream. Acta Physiol Scand1988; 134: 223. Google Scholar 7 : Measurement of renal pelvis pressures during endourologic procedures. Urology1987; 30: 472. Google Scholar 8 : Infundibular stenosis after percutaneous nephrolithotomy. J Urol2002; 167: 35. Link, Google Scholar 9 : Clinical significance of fever after percutaneous nephrolithotomy. Urology1998; 52: 48. Google Scholar 10 : Bacteriology of infected stones. Urology1973; 2: 627. Google Scholar From the Department of Urology, University of California at Davis, Sacramento, California© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byAlsyouf M, Abourbih S, West B, Hodgson H and Baldwin D (2018) Elevated Renal Pelvic Pressures during Percutaneous Nephrolithotomy Risk Higher Postoperative Pain and Longer Hospital StayJournal of Urology, VOL. 199, NO. 1, (193-199), Online publication date: 1-Jan-2018.Assimos D (2018) Re: Animal Experimental Study to Test Application of Intelligent Pressure Control Device in Monitoring and Control of Renal Pelvic Pressure during Flexible UreteroscopyJournal of Urology, VOL. 196, NO. 3, (959-959), Online publication date: 1-Sep-2016.Korets R, Graversen J, Kates M, Mues A and Gupta M (2018) Post-Percutaneous Nephrolithotomy Systemic Inflammatory Response: A Prospective Analysis of Preoperative Urine, Renal Pelvic Urine and Stone CulturesJournal of Urology, VOL. 186, NO. 5, (1899-1903), Online publication date: 1-Nov-2011. Volume 168Issue 4 Part 1October 2002Page: 1348-1351 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.Keywordspostoperative complicationskidney calculipressurefeverkidneyMetricsAuthor Information Scott A. Troxel More articles by this author Roger K. Low More articles by this author Expand All Advertisement PDF downloadLoading ...