History of urosepsis, urinary obstruction (especially persistent on day of PCNL), staghorn calculus, struvite stone composition, chronic GU tube (foley, PCN, SPT, JJ stent etc), and bowel in continuity with collecting system (ileal loop urinary diversion, ileal ureter, bladder augment, etc) are all associated with high rates of post PCNL SIRS. Maximal decompression and one week of prophylactic antibiotics (cipro or nitorfurantoin) ahead of PCNL are protective against post-PCNL SIRS/Sepsis.
In my experience (Anecdotal) poor performance status ahead of PCNL (as exhibited by wheelchair use) often is associated with post-PCNL SIRS/Sepsis.
In my opinion, to keep a low intrarrenal pressure during the surgery is one of the most important factors to prevent the post-PCNL.SIRS sepsis.
though the question is specified at Post PCNL SIRS but we should consider general predisposing factors ...immune state, coagulation profile, respiratory diseases, cardiovascular state, and occurrence of intra operative and post operative hemorrhage....
I think that the most important factors for causing postoperative SIRS, would be 1- preoperative urine cultrue , 2- stone culture 3- renal pelvis urine culture 4- intrarenal pressure during surgery (Dr J.Valdiva) , yes, there may be other factors , but these considered the most contributing factors
I think up to my mind there are no studies covering this issue, if you have please tell us...
there are about 3 or 4
one of the best is
Risk factors for systemic inflammatory response syndrome
following percutaneous nephrolithotomy
Tunc Erdil • Yakup Bostanci • Ender Ozden •
Fatih Atac • Yarkin Kamil Yakupoglu •
Ali Faik Yilmaz • Saban Sarikaya
Dear Dr. Mohamed
I found in addition another study which concludes different risk factors,actually the most important of risk factors were number of tracks, and need for blood transfusion.....as you know by definition SIRS , can occur without septicemia , so to consider that infection as the lone factor in its aetiology and trying to build up the whole workup in prevention of infection may be critical. Taking pre operative urine , stone , and renal pelvis cultures may come number 2 during management if the patient had lost much blood during or after operation and required blood transfusion. High intra pelvic pressure may be a factor in bacteraemia if you are working in a closed system but in traditional PCNL there is no such situation.... in conclusion to make clear outlines for the subject the Royal college(UK) had made these definitions
* RCS definitions of:
*Bacteraemia The presence of viable bacteria in the bloodstream
*SIRS The systemic inflammatory response to a variety of clinical insults manifest by two or more of the following:-Temperature >38°C or 90 bpm
-Respiratory Rate > 20 breaths per minute or -PaCO2 > 4.3 kPa - White Cell Count > 12,000 or
Thanks for your kind reply]
i agree totally with you ,but,you know that only 26% of SIRS is infective SIRS , THAT could propagate to sepsis , so , thats why i concentrated about infectious causes
!!!
because we dont care for non infectious SIRS , AND , its self limited
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