Preoperative risk factors associated with urosepsis following percutaneous nephrolithotomy: a meta-analysis

Objective: The aim of this meta-analysis was to identify the preoperative risk factors associated with urosepsis after percutaneous nephrolithotomy. Methods: A systematic search using electronic databases was performed to analyze the preoperative risk factors associated with urosepsis following percutaneous nephrolithotomy. The search period was from January 2006 to December 2016. Results: Totally, 18 studies were included in the analysis. Nine factors were identified as significant risk factors (P<0.05). These factors as well as their OR and 95% CI were listed as follows: female gender OR=3.89 (95% CI [2.07, 7.31], age (>= 60 years) OR=1.71 (95% CI [1.23, 2.39]), diabetes mellitus OR=3.15 (95% CI [2.10, 4.72]), blood routine (White blood cells >= 10x10(9)/L) OR=2.86 (95% CI [1.66, 4.92]), urinalysis (White blood cells >= +) OR=2.43 (95% CI [1.35, 4.37]), urine culture (positive) OR=1.60 (95% CI [1.12, 2.29]), stone size (>= 2 cm) OR=1.94 (95% CI [1.49, 2.54]), staghorn stone OR=3.07 (95% CI [1.78, 5.31]), and, hydronephrosis (moderate-severe) OR=1.57 (95% CI [1.02, 2.43]). No significant difference was observed in terms of blood pressure, use of antibiotics before surgery and history of surgery. Conclusions: In summary, female gender, age (>= 60 years), diabetes mellitus or history of preoperative infection, larger stones (>= 2 cm), staghorn stone and severe hydronephrosis are identified as the possible risk factors of urosepsis after percutaneous nephrolithotomy. Recognition of these factors can be useful in early diagnosis and management of urosepsis. Thus, clinicians should pay attention to high risk patients to reduce the incidence of postoperative urosepsis.