Gender-Specific Risk Factors for Infectious Complications Post-PCNL

Overview

This study analyzed 492 patients undergoing percutaneous nephrolithotomy (PCNL) to identify gender-specific predictors of infectious complications. Female patients demonstrated a higher risk of postoperative infections, influenced by distinct clinical and procedural factors compared to males.

Background

Percutaneous nephrolithotomy (PCNL) is the preferred surgical treatment for large and complex kidney stones, offering effective stone clearance with minimal trauma. Despite its benefits, PCNL carries risks of postoperative complications, particularly infectious events such as fever and sepsis. Established risk factors include positive urine cultures, diabetes, stone burden, and operative time. Recent evidence suggests gender differences in infection risk, with females more prone to stone-related infections, but sex-specific risk factors post-PCNL remain underexplored.

Data Highlights

Key Findings

• Female gender is associated with a higher risk of infectious complications following PCNL.
• Preoperative positive bladder urine cultures and stone infection are significant predictors of postoperative infections.
• Clinical factors such as diabetes mellitus, multiple access tracts, larger stone burden, and prolonged operative time contribute to infection risk.
• Female patients exhibit distinct anatomical and microbiological urinary tract characteristics influencing infection susceptibility.
• Tailored perioperative management considering gender-specific risk factors may improve postoperative outcomes.

Clinical Implications

Clinicians should incorporate gender-specific risk stratification when planning PCNL, recognizing that female patients may require more vigilant infection prevention strategies. Preoperative urine culture screening and targeted antibiotic therapy remain critical, especially in females. Awareness of procedural factors such as operative time and access tracts can guide surgical planning to minimize infectious risks.

Conclusion

This study highlights the importance of gender as a determinant of infectious complications after PCNL, underscoring the need for personalized perioperative management. Integrating sex-specific risk factors can enhance patient outcomes and reduce postoperative infections.

References

1. Clinical and procedural risk factors for PCNL complications
2. Gender differences in urolithiasis and infection risk
3. Charlson Comorbidity Index for comorbidity assessment
4. PCNL-adjusted Clavien-Dindo classification for complications