Ramazan UGUR, Emin Taha KESKIN, Ahmet Eren SAGIR, Abdullah ZILAN, Direnc OZBORU, Halil Lutfi CANAT
The Medical Bulletin of Haseki - 2026;64(2):138-146
Aim: Percutaneous nephrostomy (PN) is a well-established method for urgent decompression in stone-related urinary obstruction; however, post-procedural sepsis remains a significant concern. This study aimed to determine the incidence and risk factors for sepsis following PN in patients with stone-related urinary tract obstruction who did not have pre-existing sepsis. Methods: This retrospective observational cohort included patients who underwent PN for stone-related urinary tract obstruction. Patients were classified as non-septic (n=290) or septic (n=18) based on postoperative (post-op) sepsis. Demographic, clinical, laboratory, microbiological, and radiological parameters were analyzed. Univariate and multivariable logistic regression analyses were performed to identify independent predictors of post-op sepsis. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the discriminative performance of the prediction model. Results: Three hundred and eight patients were included; 18 (5.9%) developed post-op sepsis. Patients with post-op sepsis had significantly higher preoperative (pre-op) body temperature, white blood cell count and neutrophil count, C-reactive protein (CRP) levels, neutrophil-to-lymphocyte ratio, and systemic immune-inflammation index. Bacterial growth in nephrostomy catheter cultures and perirenal fat stranding were more frequent in the sepsis group. Multivariable analysis identified elevated body temperature, higher pre-op neutrophil count, increased pre-op CRP, and bacterial growth in nephrostomy catheter cultures as independent predictors of post-op sepsis. ROC curve analysis showed an area under the curve (AUC) of 0.925 for the prediction model, while body temperature, pre-op CRP, and neutrophil count had AUCs of 0.777, 0.750, and 0.746, respectively. Conclusion: Percutaneous nephrostomy relieves urinary tract obstruction but may also lead to serious complications such as sepsis. An increased body temperature, a high pre-op neutrophil count, a high pre-op CRP level, and bacterial growth in nephrostomy catheter cultures were all independent predictors, and the prediction model showed excellent discrimination.
