Prophylaxis with nitrofurantoin (NFT) a week before percutaneous nephrolithotomy (PNL) may help to prevent urosepsis and endotoxemia in patients with larger kidney stones and hydronephrosis (HDN), according to the results of a randomized, controlled trial.
Investigators studied 101 patients with HDN and stones 2.5 cm or more in diameter undergoing PNL. All had sterile mid-stream urine. Of the 101 patients, 48 received sustained-release nitrofurantoin 100 mg twice daily for seven days preoperatively. The remaining 53 patients did not. The two groups were similar with respect to age, gender, degree of HDN, stone burden, duration of operation, and intraoperative blood loss.
No patient in the nitrofurantoin group had a positive renal pelvic urine culture compared with 9.8% of controls, the researchers reported in Urology (2011;77:45-49). In addition, compared with controls, the nitrofurantoin group had a significantly lower rate of endotoxemia (17.5% vs. 41.9%) and systemic inflammatory response syndrome (19% vs. 49%).
“The risk of post-PNL urosepsis is higher in patients with larger stones and obstructed PCS despite standard perioperative antibiotic prophylaxis,” the authors concluded. “NFT prophylaxis for a week before PNL is beneficial in the prevention of urosepsis and endotoxemia in patients with larger stones and HDN.”