Does preoperative nephrostomy increase the incidence of wound infection after nephrectomy?

Objectives. To determine whether patients with nephrostomy after simple nep hrectomy more often had postoperative wound complication than did matched p atients without nephrostomy. Methods. The hospital records of patients who underwent retroperitoneal sim ple nephrectomy were evaluated, and the following data were retrieved: age, indication for nephrectomy and nephrostomy insertion, medical history, uri ne culture, antibiotic regimen, time elapsed from nephrostomy insertion to nephrectomy, surgical technique, type of complication, time elapsed from su rgery to complication, treatment, and outcome of complications. Results, Thirty-one patients (mean age 57.9 years, +/- SE 3.0) were evaluat ed. Seven (31.8%) of the 22 patients without nephrostomy (group 1) had woun d infection compared with 7 (77.7%) of the 9 patients with nephrostomy (gro up 2) (P < 0.05), All 9 group 2 patients had infected urine compared with 1 1 of the 22 in group 1 (P < 0.05). Complications were apparent within a me dian time of 1 month (+/- SD 0.9) from surgery in group 2, whereas the medi an time to complication was 4.5 months (+/- SD 3.7, P < 0.05) in group 1, T wo patients in group 2 died of wound infection and sepsis. Both groups were similarly matched for age, indication for nephrostomy and nephrectomy, per ioperative and operative techniques, and histologic findings of the removed kidneys. All patients received antibiotic agents at the time of surgery. Conclusions. Patients with nephrostomy inserted because of pyonephrosis or to relieve obstruction who underwent simple nephrectomy because of unrecove rable renal damage had earlier and more frequent wound infections than pati ents who underwent the identical procedure without nephrostomy. UROLOGY 53: 50-52, 1999. (C) 1999, Elsevier Science Inc. All rights reserved.