Can Tumor Necrosis Factor-α and Interleukin-6 Be Used as Prognostic Markers of Infection following Ureteroscopic Lithotripsy?

Introduction. Ureteroscopic lithotripsy (URS) although highly effective for the treatment of ureteral stones is associated with certain complications, the more common of which are postoperative fever and infection. In the present study we aimed to evaluate the levels of serum cytokines in patients undergoing ureteroscopic lithotripsy and investigate any possible correlation between levels of cytokines and infectious complications after URS. Materials and Methods. Thirty patients (19 males, 11 females), with a mean age of 47 (range: 26–68) that underwent URS lithotripsy for ureteral stones, and 10 healthy volunteers serving as the control group were enrolled in this study. Serum samples for TNF-α and IL-6 were obtained before surgical intervention and after 1, 24, and 48 hours and 2 , 24, and 48 hours, respectively. The preoperative and postoperative levels were compared and correlated with the possible complications after URS. Results. Serum TNF-α levels were statistically significant, increased 1 hour ( ) and 48 hours ( ) after operation. IL-6 levels were found statistically significant, elevated after 2 and 24 hours from the URS ( ). In 2 patients we observed postoperative fever (>38.5°C). These two patients had high preoperative values of TNF-α and IL-6 ( 30 and 50？pg/mL, resp.) and these values increased postoperatively. Conclusion. High preoperative levels of serum TNF-α and IL-6 may indicate a predisposition for postoperative inflammation and infection following URS lithotripsy. 1. Introduction Urolithiasis is one of the most common urological diseases with various surgical treatments available for its management. One of most utilized surgical modalities is ureteroscopy (URS) with endoscopic stone lithotripsy [1]. URS, either rigid or flexible, is the treatment of choice for almost all ureteral stones and for certain cases of intrarenal lithiasis. Although its therapeutic benefits are recognized, URS is associated with complications that range from pain and hematuria to ureteral perforation, ureteral avulsion, fever, sepsis, and death [2]. With regard to the infectious complications of URS lithotripsy, there are certain serum markers including pro-inflammatory cytokines that are gaining importance in clinical practice [3–5]. Cytokines are a group of peptides that regulate the humoral and cellular components of the immune system and in vivo inflammatory responses. Interleukin-6 (IL-6) is an inducer of activation and differentiation of B and T cells during inflammatory responses. IL-6 also activates the vascular endothelium in the process of