Abstract: Objective To reduce the incidence of SIRS and sepsis in patients with upper urinary tract calculi and pyonephrosis in non-acute infection stage by perfusion of povidone iodine and negative pressure aspiration sheath into the renal collecting system on the surgical side.
Methods The clinical data of PCNL patients with pyonephrosis and upper urinary calculi from April 2019 to August 2019 were retrospectively analyzed.5 cases were actually included.Those who met any of the following conditions before operation were included in the analysis,including positive nitrite in urine,positive urine culture,abdominal CT plain scan considering pyonephritis or repeated turbidity of urine with significant increase of urinary white blood cells.Ultrasound-guided percutaneous nephrolithotomy confirmed the drainage of purulent urine in 5 cases,including 4 cases with positive urine culture 48 hours before operation.Negative pressure of these 5 cases was evaluated in terms of lithotripsy rate,liver and kidney function,inflammation and infection index,length of operation and lithotripsy and complications.
Results 80%(4/5) of the patients with ureterolithiasis and pyonephrosis treated by the above method in the first stage achieved the effect of primary lithotripsy.One patient underwent stage Ⅱ flexible ureteroscopic surgery because of the stone burden;all patients had no perioperative liver and kidney function damage（P<0.05）.Preoperative procalcitonin level and preoperative blood C-reactive protein(CRP) level compared with postoperative had not significantly different（P<0.05）.No sepsis occurred in one case,SIRS occurred in one case and improved after anti-infection treatment for 3 hours.The average length of lithotripsy and operation were 39 minutes and 60 minutes,respectively.No complications such as puncture injury,severe bleeding,ureteral injury and allergic reaction occurred.
Conclusion PCNL combined with negative pressure aspiration sheath for primary treatment of renal and ureteral calculi complicated with pyonephrosis by povidone iodine perfusion can reduce hospitalization time and avoid long-term indwelling nephrostomy,while ensuring the safety and effectiveness of lithotripsy.

Key words: povidone iodine, pyonephrosis, negative pressure aspiration sheath, sepsis