Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 Jul 17;43(1):440.
doi: 10.1007/s00345-025-05836-6.

Which neurogenic bladder patients are at higher risk of sepsis after percutaneous nephrolithotomy?

Gustavo Perrone #  1 , Alexandre Danilovic #  2 , Lucas Dias  3 , Giovanni Marchini  3 , Fabio Torricelli  3 , Carlos Batagello  3 , Fabio Vicentini  3 , Rodrigo Perrella  3 , William C Nahas  1 , Eduardo Mazzucchi  3
Affiliations
Meta-Analysis

Which neurogenic bladder patients are at higher risk of sepsis after percutaneous nephrolithotomy?

Gustavo Perrone et al. World J Urol. .

Abstract

Purpose: To identify predictors of sepsis following percutaneous nephrolithotomy in patients with neurogenic bladder, without investigating causal pathways.

Methods: We retrospectively analyzed a consecutive sample of patients with neurogenic bladder who underwent percutaneous nephrolithotomy at our referral center between 2009 and 2020. We also systematically searched PubMed until February 2025 for studies that investigated neurogenic patients undergoing this procedure. We then performed a single-arm meta-analysis of postoperative sepsis, including our own data, and meta-regressions to search for predictors.

Results: In our cohort, sepsis rate was 6% [1%; 19%], 2/36 patients. The Charlson Comorbidity Index was the only predictor (p = 0.02). In the meta-cohort (13 cohorts, 2,369 patients), the combined sepsis rate was 12% [7%; 17%], despite high heterogeneity (I2 = 75%), with no evidence of publication bias (p = 0.09). We identified younger age (p = 0.04), non-urethral urinary diversions (p = 0.04)-particularly ileal conduits (p < 0.001)-and non-traumatic etiologies (p = 0.02), especially spina bifida (p = 0.009), as predictors of sepsis.

Conclusion: We recommend the development of a targeted antibiotic prophylaxis protocol, tailored to these predictors, for patients with neurogenic bladder undergoing percutaneous nephrolithotomy. We motivate further research on causal pathways.

Keywords: Kidney stone; Neurogenic bladder; Percutaneous nephrolithotomy; Postoperative complication; Sepsis.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests. Ethical approval: The principles of the Declaration of Helsinki were followed. Approval was granted by the Research Ethics Committee of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (75906623.0.0000.0068). Declaration of generative AI and AI-assisted technologies in the writing process: During the preparation of this work the authors used ChatGPT 4o (OpenAI) in order to improve language and readability. After using this tool, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.

References

    1. Skolarikos A, Jung H, Neisius A et al (2025) EAU guidelines on urolithiasis. EAU guidelines Edn presented at the EAU annual congress madrid. ISBN 978-94-92671-29-5
    1. Schwaderer AL, Oduguwa A, Kusumi K (2018) Urinary stone disease in pediatric and adult metabolic bone clinic patients. Urolithiasis. https://doi.org/10.1007/s00240-017-0968-z - DOI - PubMed
    1. Tozsin A, Akdere H, Guven S, Ahmed K (2024) A systematic review on urolithiasis in children with neurological disorders. World J Urol 42:635. https://doi.org/10.1007/s00345-024-05330-5 - DOI - PubMed
    1. Assimos D, Krambeck A, Miller NL et al (2016) Surgical management of stones: American urological association/endourological society guideline, PART I. J Urol. https://doi.org/10.1016/j.juro.2016.05.090 - DOI - PubMed
    1. Assimos D, Krambeck A, Miller NL et al (2016) Surgical management of stones: American urological association/endourological society guideline, PART II. J Urol. https://doi.org/10.1016/j.juro.2016.05.091 - DOI - PubMed

Publication types

LinkOut - more resources