Postoperative infection after ureterorenoscopic lithotripsy in Songkhla Hospital
DOI:
https://doi.org/10.52786/isu.a.74Keywords:
URSL, perioperative infection, urinary tract infection, risk factorsAbstract
Objective: Ureterorenoscopic lithotripsy (URSL) is the procedure of choice for treatment of ureteral stones. Postoperative acute pyelonephritis (APN) is a serious complication after URSL which may potentially progress to urosepsis and death. In this study we aimed to explore and record potential predictive factors associated with postoperative APN after URSL.
Materials and Methods: Ninety patients (2016-2022) with ureteral stone managed with URSL were identified. Postoperative APN was defined in patients with a body temperature > 38 °C which persisted for at least 48 hours after URSL with clinical symptoms and/or urine culture was positive for organism growth. Multivariable analysis with logistic regression was used to identify predictive factors for postoperative APN.
Results: Seven patients (7.8%) experienced postoperative APN and six patients (85.7%) developed systemic inflammatory response syndrome. All patients were managed conservatively with selective antibiotics, specifically treated with meropenem (n = 3), piperacillin/tazobactam (n = 3), and imipenem/cilastatin (n = 1). Most patients with postoperative APN were women (5/7 patients, 71.4%). The median age of the seven postoperative APN patients was 57.6 vs 54 years (p = 0.48) and the hospital stay was longer 5 vs 2 days, (p < 0.01). Preoperative APN was found in 12 patients (13.3%) and six patients (50%) developed perioperative APN. The multivariable analysis, showed that the only independent factor of postoperative APN was a history of preoperative APN
Conclusion: Postoperative infection is a serious condition after URSL that can increase the risk of morbidity and mortality. A single significant risk factor for postoperative infection was a history of preoperative APN. These patients should receive rigorous postoperative care to avoid serious complications.
References
Scales CD, Smith AC, Hanley JM, Saigal CS. Prevalence of kidney stones in the United States. Eur Urol 2012;62:160-5.
Lojanapiwat B. Urolithiasis. In: Choonhaklai V, Santingamkul A, editors. Common Urologic Problems for Medical Student. Bangkok: Beyond Enterprise; 2016. p. 82-95.
RomeroV, AkpinarH, AssimosDG. Kidneystones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol 2010;12:e86-96.
Morrison JC, Kawal T, Van Batavia JP, Srinivasan AK. Use of ultrasound in pediatric renal stone diagnosis and surgery. Curr Urol Rep 2017;18:227-33.
Ozgor F, Sahan M, Cubuk A, Ortac M, Ayranci A, Sarilar O. Factors affecting infectious complications following flexible ureterorenoscopy. Urolithiasis 2019;47:481-6.
Bhojani N, Miller LE, Bhattacharyya S, Cutone B, Chew BH. Risk factors for urosepsis after ureteroscopy for stone disease: a systematic review withmeta-analysis. J Endourol 2021;35:991-1000.
Knoll T, Jessen JP, Honeck P, Wendt-Nordahl G. Flexible ureterorenoscopy versus miniaturized PNL for solitary renal calculi of 10–30 mm size. World J Urol 2011;29:755-9.
de la Rosette J, Denstedt J, Geavlete P, Keeley F, Matsuda T, Pearle M, et al. The Clinical Research Office of the Endourological Society Ureteroscopy Global Study: indications, complications, and outcomes in 11,885 patients. J Endourol 2014;28:131-9.
Perez Castro E, Osther PJS, Jinga V, Razvi H, Stravodimos KG, Parikh K, et al. Differences in ureteroscopic stone treatment and outcomes for distal, mid-, proximal, or multiple ureteral locations: The Clinical Research Office of the Endourological Society Ureteroscopy Global Study. Eur Urol 2014; 66:102-9.
Bai Y, Wang X, Yang Y, Han P, Wang J. Percutaneous nephrolithotomy versus retrograde intrarenal surgery for the treatment of kidney stones up to 2 cm in patients with solitary kidney: a single center experience. BMC Urol 2017;17:9.
Cindolo L, Castellan P, Scoffone CM, Cracco CM, Celia A, Paccaduscio A, et al. Mortality and flexible ureteroscopy: analysis of six cases. World J Urol 2016;34:305-10.
Sugihara T, Yasunaga H, Horiguchi H, Nishimatsu H, Kume H, Ohe K, et al. A nomogram predicting severe adverse events after ureteroscopic lithotripsy: 12 372 patients in a Japanese national series. BJU Int 2013;111:459-66.
Omori C, Hori S, Otsuka K, Iida K, Morizawa Y, Naoi M, et al. The risk factors and chemoprevention of febrile urinary tract infection after transurethral ureterolithotripsy. Nihon Hinyokika Gakkai Zasshi 2018;109:74-84 (in Japanese).
Fan S, Gong B, Hao Z, Zhang L, Zhou J, Zhang Y, et al. Risk factors of infectious complications following flexible ureteroscope with a holmium laser: a retro- spective study. Int J Clin Exp Med 2015;8:11252-9.
Yoshida S, Takazawa R, Uchida Y, Kohno Y, Waseda Y, Tsujii T. The significance of intraoperative renal pelvic urine and stone cultures for patients at a high risk of post-ureteroscopy systemic inflammatory response syndrome. Urolithiasis 2019;47:533-40.
Uchida Y, Takazawa R, Kitayama S, Tsujii T. Predictive risk factors for systemic inflammatory response syndrome following ureteroscopic laser lithotripsy. Urolithiasis 2018;46:375-81.
Chugh S, Pietropaolo A, Montanari E, Sarica K, Somani BK. Predictors of urinary infections and urosepsis after ureteroscopy for stone disease: a systematic review from EAU Section of Urolithiasis (EULIS). Curr Urol Rep 2020;21:16.
Seike K, Ishida T, Taniguchi T, Fujimoto S, Kato D, Takai M, et al. Low body mass index as a predictive factor for postoperative infectious complications after ureterorenoscopic lithotripsy. Medicina 2021; 57:1100.
Mariappan P, Loong CW. Midstream urine culture and sensitivity test is a poor predictor of infected urine proximal to the obstructing ureteral stone or infected stones: a prospective clinical study. J Urol 2004;171:2142-5.
Skolarikos A, Jung H, Neisius A, Petřík A, Somani B, Tailly T, et al. EAU guideline on Urolithiasis [Internet]. 2023 [cited 2023 June 15]. Available from: https://d56bochluxqnz.cloudfront.net/documents/ full-guideline/EAU-Guidelines-on-Urolithia- sis-2023.pdf
Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, et al. Surgical manage- ment of stones: American Urological Association/ Endourological Society Guideline, PART I. J Urol 2016;196:1153-60.
Itami Y, Miyake M, Owari T, Iwamoto T, Gotoh D, Momose H, et al. Optimal timing of ureteroscopic lithotripsy after the initial drainage treatment and risk factors for postoperative febrile urinary tract infection in patients with obstructive pyelonephritis: a retrospective study. BMC Urol 2021;21:10.
Toprak T, Şahin A, Kutluhan MA, Akgul K, Danacıoğlu YO, Ramazanoğlu MA, et al. Does duration of stenting increase the risk of clinical infection? Arch Ital Urol Androl 2020;91:237-40.
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