Novel Irrigation Protocol for Renal Pelvis Sterilization during PCNL: A Pilot Study.

Abstract

While percutaneous nephrolithotomy (PCNL) remains the treatment modality of choice for kidney stones larger than 2 cm, infectious complications are the most common, ranging from 5 to 32%. We present here a novel technique for potentially improving collecting system sterility during PCNL and our initial post-operative outcomes. Retrospective chart analysis of our irrigation protocol was collected from our first 56 patients between February to July 2019. Traditional prone PCNL was performed in standard fashion using fluoroscopic guidance. Using a ureteral catheter was placed cystoscopically, a renal pelvis urine culture was taken and subsequently 10mL of betadine solution was instilled into the collecting system. Gentamicin 80 mg/3L normal saline was utilized as irrigant fluid for the first 6L of irrigation. From this cohort, patients were 57% female and mean age was 60±14 years. About 23% of patients were diabetic and 55% were hypertensive. Seventy percent of patients stone burden >2cm and no patients had stone burden less than 1 cm. Fifteen patients had positive urine cultures treated preoperatively, while 4 patients had contaminated cultures. All patients were treated with our antibiotic irrigation and betadine protocol regardless of pre-operative cultures or antibiotics. Mean baseline creatinine was 0.95±0.41, with a mean change of 0.18 post-op day 1. Of the 15 (26%) of 56 patients with a SIRS response (2 of following 4 criteria: WBC<4 or >12; HR >90, hypothermia < 96.8F or hyperthermia >100.4F, RR>20), only 6 patients (11%) were febrile, and two patients had positive blood cultures (3%). There were no adverse reactions to the betadine or antibiotic irrigation. We present here our initial experience of a new technique for renal pelvis sterilization and its safety and feasibility using intrarenal instillation of betadine and antibiotic irrigation.