Post Percutaneous Nephrolithotomy Urinary Tract Infection: A Clinical Dilemma

Renal stone disease is a global problem with a 12% global prevalence.For the management of renal stones percutaneous nephrolithomy (PCNL) is the urological intervention of choice.There have been several instances of post-PCNL urinary tract infection (UTI) despite a sterile pre-operative urine culture.To look into the possible factors that may be associated with such an outcome, we observed 142 patients undergoing PCNL with a pre-requisite of sterile pre-operative urine culture, no indwelling double J stents, and no fever episodes within the last seven days of admission for PCNL.Results: 19% of 142 patients suffered post-PCNL UTI.We noted that the presence of multiple stones, stone burden of greater than 3 cm, and perinephric fat stranding in preoperative CT scan of the KUB region were the preoperative factors associated with post-PCNL UTI.Intraoperative factors that were found associated were the size of tract dilatation (16 Fr or greater than 16 Fr), number of renal access tracts, and duration of surgery.We also found that patients with controlled diabetes behaved as the non-diabetic population for the incidence of UTI post-PCNL.