E52 Positive stone culture predicts post-PCNL morbidity

THURSDAY 10 SEPTEMBER 2015 / EUROPEAN UROLOGY SUPPLEMENTS 14 (2015) 29–78

E52 Positive stone culture predicts post-PCNL morbidity Kalejaiye O., Dukic I., Collin N., Jacobsen K., Keeley F., Timoney A., Philip J. Southmead Hospital, Dept. of Urology, Bristol, United Kingdom Introduction and objectives: Percutaneous Nephrolithotomy (PCNL), the gold standard treatment for large renal calculi is associated with significant morbidity. Post-operative sepsis increases morbidity and length of hospital stay. Empiric use of broad spectrum antibiotics increases the risk of resistance selection. This study evaluates pre-op urine and stone culture results’ association with sepsis and in-hospital stay. Materials and methods: Over a two-year period ending October 2014; PCNL patients’ records/investigations were reviewed. All patients had a pre-operative mid-stream urine (MSU) culture done pre-operatively, treated with sensitive antibiotics appropriately pre- and peri-operatively. Stone culture and biochemical analysis, post-operative clinical outcome including febrile episodes and antibiotic usage were evaluated. Results: 93 PCNL procedures were performed with 61 having a positive stone culture. Median length of stay was significantly increased in patients with a positive stone culture (4 days vs. 5 days, p=0.026). Significant association between positive pre-op MSU and positive stone culture was noted [79%; p<0.0001]. 67% of procedures were performed on women who were significantly more likely to have a positive stone culture (p0.02). Patients who had a febrile episode and were stone culture positive had a mean hospital stay of 10 days versus 4 days for those who were negative (p<0.01). Conclusions: A positive pre-op MSU culture in PCNL patients was associated with more febrile episodes and an increased length of stay. Positive stone culture was associated with increased morbidity. Concordance of pre-op urine and stone cultures suggest that targeted neo-adjuvant antibiotics could help reduce the risk of febrile episodes, sepsis and morbidity in PCNL patients. Emerging technologies to rapidly identify organisms could help target appropriate narrow spectrum antibiotics immediately peri-operatively, thereby reducing the risk of resistance induction. E53 Percutaneous nephrolithotomy (pnl) in patients with preoperative pyuria: Evaluation of postoperative infectious complications Yilmaz Ö., Kurul Ö., Madenoğlu U., Soydan H., Yeşildal C., Ateş F. Gata Haydarpasa Training Hospital, Dept. of Urology, Istanbul, Turkey Introduction and objectives: Endourologic surgery is likely to create high risk for surgical complications such as urinary sepsis in the presence of active urinary tract infection. In this study, patients who had pyuria and nitrite (+) urinalysis were investigated if they had been early postoperative infectious complications. Materials and methods: Patients who underwent PNL in our clinic due to kidney stone disease with the data of pyuria and nitrites (+) routine preoperative urinalysis were reviewed retrospectively. Preoperative urine culture taken from patients with no signs of active infection, and 24 to 48 hours prior the operation empiric broad-spectrum parenteral antibiotic therapy was started. Patients who had negative urine culture underwent surgery. Al of them were under treatment with antibiotics and treatment was continued in postoperative period until the nephrostomy catheter was removed. Patients with positive urine culture had been started appropriate antibiotic treatment

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and the surgery had been postponed. Age of the patients, sex, stone size, stone location, number of entries, the presence of hydronephrosis, postoperative fever, bleeding data were evaluated. Results: Mean Age Gender Male Female Stone Location Pelvis Upper calyx Middle calyx Lower calyx Avarage stone size (mm) Preoperative hydronephrosis Access 1 2 Postoperative Bleeding Postoperative Fever

42.17(20-74) 20 14 22 1 1 10 27.3 26 32 2 2 6

Conclusions: Although PNL is contraindicated for patients with active urinary tract infection, in our study patients with pyuria and nitrite (+) urinalysis and without positive preoperative urine culture and no clinical signs of urinary infections underwent PNL without any increase of infectious complications. Controlled studies are required for a final decision on the issue. E54 Complications of percutaneous nephrolithotomy (PCNL) according to the CROES Clavien classification: A comparison between novice and expert urologists Arzoz Fabregas M., Alves Oliveira M., Calaf Perisé O., Garcia De Manuel G., Bayona Arenas S., Ibarz Servio L. Hospital Universitari Germans Trias i Pujol, Dept. of Urology, Badalona, Spain Introduction and objectives: In order to improve the reliability and consistency of reporting adverse outcomes of PCNL, the CROES PCNL study group recently validated the Clavien classification of postoperative complications for use with PCNL. PCNL is a complicated procedure, with a difficult learning curve for urologists. The aim of this study was to evaluate adverse outcomes in PCNLs performed by a novice urologist and to compare them to those in PCNLs performed by experts. Materials and methods: The first 23 consecutive PCNLs performed by a novice urologist without direct supervision by an expert were evaluated and compared with 124 consecutive PCNLs performed by two experts in PCNL over a 3-year period. Complications (scored using the CROES Clavien system), epidemiological factors, stone characteristics, surgical aspects, and results were compared between the two groups. Results: A total of 147 PCNLs were performed in our department in the last 3 years: 23 (15.6%) by a novice and 124 (84.4%) by two experts. The mean stone size was 23.7±5.65mm for the novice and 23.3±6.7mm for the experts (P=0.8). The mean surgical time was 130.9± 41.39 minutes for the novice and 120±35.5 minutes for the experts (P=0.2). BMI was 25.8 ±3.9 kg/m2 in the novice’s patients, compared to 28.9±5.9 kg/m2 in the experts’ patients (P=0.01). The stone-free rate was 65.2% for the novice and 64.5% for the experts (P=0.5). Complications occurred in 6 (26.1%) of the PCNLs performed by the novice (2 grade 1, 3 grade 2, 1 grade 3B) and in 21 (16.9%) of those performed by the experts (6 grade 1, 7 grade 2, 4 grade 3A, 2 grade 3B, 2 grade 4A) (P=0.36). Conclusions: Although post-operative complications of PCNL occur more frequently with less experienced urologists,