2022 Volume 55 Issue 5 Pages 301-307
［Objective］Polymyxin B‒immobilized fiber column direct hemoperfusion (PMX) is used to treat urosepsis/septic shock after flexible transurethral lithotripsy (f‒TUL). We retrospectively examined the usefulness of PMX for urosepsis/septic shock after f‒TUL. ［Methods］Of 728 patients who underwent f‒TUL for renal/ureteral lithiasis in a 3‒year period (from Jan. 1, 2016), 16 were treated with PMX. Of these, 5 required nephrectomy due to pyonephrosis. We compared the following between the patients that did (nephrectomy group) and did not (non‒nephrectomy group) undergo nephrectomy： 1) patient background factors, clinical variables, PMX‒related items, and the clinical course； 2) the Sequential Organ Failure Assessment (SOFA) score, mean arterial pressure (MAP), hourly urinary output, and body temperature. ［Results］In the nephrectomy group, large (≥20 mm) calculi or staghorn calculi were found in 60％ of patients. Gram‒negative bacilli were detected in preoperative urine cultures in most patients, and all patients received preoperative antibiotic therapy. On average, PMX was started 3‒4 h after the completion of f‒TUL in both groups. The 28‒day mortality rate was 0％ in both groups. MAP was significantly elevated after PMX in both groups. Significant improvements in the SOFA score were seen after PMX in the non‒nephrectomy group, whereas the SOFA score worsened after PMX in the nephrectomy group. Only a small increase in urinary output was observed after PMX in the latter group. PMX treatment for urosepsis/septic shock led to improved hemodynamics in patients that experienced sustained shock after f‒TUL. Nephrectomy should be considered if the patient’s SOFA score worsens after PMX.
