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Development of sudden refractory hypotension resulting from urosepsis in the post-anesthesia care unit after percutaneous nephrolithotomy for renal calculi: a case report
Med Biol Sci Eng 2019;2(2):55-59
Published online July 31, 2019
© 2019 Medical Biological Science and Engineering.

Gi-Ho Koh1, Doo-Hwan Kim2, Jihion Yu2, Seungsoo Ha2, Sang-A Lee2, Jai-Hyun Hwang2, Young-Kug Kim2, Jun-Young Park2

Department of Anesthesiology and Pain Medicine, 1Chosun University Hospital, Gwangju, 2Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Correspondence to: Jun-Young Park
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
Tel: +82-2-3010-1415
Fax: +82-2-3010-6790
E-mail: anesthesia.pains@gmail.com
ORCID: https://orcid.org/0000-0003-4476-4945
Received March 11, 2019; Revised March 14, 2019; Accepted March 14, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Percutaneous nephrolithotomy (PNL) is a relatively safe and effective procedure for the management of nephrolithiasis but is associated with severe complications. We report the case of a 76-year-old woman who underwent PNL for renal calculi removal. Preoperative urinalysis detected a large number of white blood cells and, on culture, Escherichia coli was detected. After an uneventful recovery from general anesthesia, she developed tachycardia, high fever, severe shivering, and hypotension in the post-anesthesia care unit. She was diagnosed with urosepsis associated with PNL and was transferred to the intensive care unit. Urosepsis and refractory hypotension persisted despite meticulous fluid management and vasopressor and inotropic agent administration. On postoperative day 5, she was hemodynamically stable and was transferred to a general ward. On postoperative day 12, she was discharged without any complications. Urosepsis after PNL can be catastrophic; therefore, early detection and optimal treatment are necessary to improve the postoperative outcome.
Keywords : Kidney calculi; Nephrolithotomy, Percutaneous; Shock, Septic; Anesthesia recovery period
References
  1. Wagenlehner FM, Lichtenstern C, Rolfes C, Mayer K, Uhle F, Weidner W, et al. Diagnosis and management for urosepsis. Int J Urol 2013;20:963-70.
    Pubmed CrossRef
  2. Mariappan P, Smith G, Moussa SA, Tolley DA. One week of ciprofloxacin before percutaneous nephrolithotomy significantly reduces upper tract infection and urosepsis: a prospective controlled study. BJU Int 2006;98:1075-9.
    Pubmed CrossRef
  3. Olvera-Posada D, Tailly T, Alenezi H, Violette PD, Nott L, Denstedt JD, et al. Risk factors for postoperative complications of percutaneous nephrolithotomy at a tertiary referral center. J Urol 2015;194:1646-51.
    Pubmed CrossRef
  4. Oner S, Okumus MM, Demirbas M, Onen E, Aydos MM, Ustun MH, et al. Factors influencing complications of percutaneous nephrolithotomy: a single-center study. Urol J 2015;12:2317-23.
    Pubmed
  5. Lai WS, Assimos D. The role of antibiotic prophylaxis in percutaneous nephrolithotomy. Rev Urol 2016;18:10-4.
    Pubmed KoreaMed
  6. Michel MS, Trojan L, Rassweiler JJ. Complications in percutaneous nephrolithotomy. Eur Urol 2007;51:899-906.
    Pubmed CrossRef
  7. Ronco C, Piccinni P, Rosner MH. Endotoxemia and endotoxin shock: disease, diagnosis and therapy. Basel: Karger; 2010.
    CrossRef
  8. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013;41:580-637.
    Pubmed CrossRef
  9. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016;315:801-10.
    Pubmed CrossRef
  10. Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, et al. Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016;315:762-74.
    Pubmed CrossRef
  11. Seitz C, Desai M, Häcker A, Hakenberg OW, Liatsikos E, Nagele U, et al. Incidence, prevention, and management of complications following percutaneous nephrolitholapaxy. Eur Urol 2012;61:146-58.
    Pubmed CrossRef
  12. Kim SH, Kim YK, Lee BJ, Hwang GS, Hwang JH, Han SM. Acute hemothorax after percutaneous nephrolithotomy: a case report. Korean J Anesthesiol 2007;52:491-4.
    CrossRef
  13. Rao PN, Dube DA, Weightman NC, Oppenheim BA, Morris J. Prediction of septicemia following endourological manipulation for stones in the upper urinary tract. J Urol 1991;146:955-60.
    Pubmed CrossRef
  14. McAleer IM, Kaplan GW, Bradley JS, Carroll SF. Staghorn calculus endotoxin expression in sepsis. Urology 2002;59:601.
    Pubmed CrossRef
  15. O’Keeffe NK, Mortimer AJ, Sambrook PA, Rao PN. Severe sepsis following percutaneous or endoscopic procedures for urinary tract stones. Br J Urol 1993;72:277-83.
    Pubmed CrossRef
  16. Kumar S, Bag S, Ganesamoni R, Mandal AK, Taneja N, Singh SK. Risk factors for urosepsis following percutaneous nephrolithotomy: role of 1 week of nitrofurantoin in reducing the risk of urosepsis. Urol Res 2012;40:79-86.
    Pubmed CrossRef
  17. Mariappan P, Smith G, Bariol SV, Moussa SA, Tolley DA. Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy: a prospective clinical study. J Urol 2005;173:1610-4.
    Pubmed CrossRef
  18. Zheng J, Li Q, Fu W, Ren J, Song S, Deng G, et al. Procalcitonin as an early diagnostic and monitoring tool in urosepsis following percutaneous nephrolithotomy. Urolithiasis 2015;43:41-7.
    Pubmed CrossRef
  19. Korets R, Graversen JA, Kates M, Mues AC, Gupta M. Post-percutaneous nephrolithotomy systemic inflammatory response: a prospective analysis of preoperative urine, renal pelvic urine and stone cultures. J Urol 2011;186:1899-903.
    Pubmed CrossRef
  20. Blackmur JP, Maitra NU, Marri RR, Housami F, Malki M, McIlhenny C. Analysis of factors’ association with risk of postoperative urosepsis in patients undergoing ureteroscopy for treatment of stone disease. J Endourol 2016;30:963-9.
    Pubmed CrossRef


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