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Hsieh TY, Chang SJ, Chueh JSC, Lee YJ. The mayo adhesive probability score predicts postoperative fever and sepsis in retrograde intrarenal surgery. Urolithiasis 2024; 52:80. [PMID: 38819457 PMCID: PMC11142997 DOI: 10.1007/s00240-024-01586-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/23/2024] [Indexed: 06/01/2024]
Abstract
Infectious complications are among the most common and potentially life-threatening morbidities of retrograde intrarenal surgery (RIRS). Few predictive tools on these complications include radiological signs. The Mayo adhesive probability (MAP) score is an image-based scoring system that incorporates two radiological signs: perinephric fat stranding and perinephric fat thickness. Previous studies have suggested an association between these signs and febrile urinary tract infection (UTI) following lithotripsy. This study aimed to evaluate the predictive factors, including the MAP score, for post-RIRS fever and sepsis. A total of 260 patients who underwent 306 RIRS between October 2019 to December 2023 due to renal or upper ureteral stones were included in this retrospective study. Patient demographics, perioperative characteristics, stone factors, radiological signs, and MAP scores were recorded. Multivariate logistic regression analysis was used to evaluate the risk factors associated with postoperative fever and sepsis. Postoperative fever and sepsis occurred in 20.8% and 8.5% of the patients, respectively. On multivariate analysis, female gender, history of recurrent UTI, larger maximal stone diameter, and higher MAP score were independent risk factors for postoperative fever and sepsis. Identifying the risk factors for post-RIRS infectious complications is imperative to providing the proper perioperative management. The MAP score is a promising, easily calculated, image-based scoring system that predicts post-RIRS fever and sepsis.
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Affiliation(s)
- Tsung-Yi Hsieh
- Department of Urology, National Taiwan University Hospital, 7 Chung Shan S. Road (Zhongshan S. Road), Zhongzheng Dist, Taipei, 100225, Taiwan (R.O.C.)
| | - Shang-Jen Chang
- Department of Urology, National Taiwan University Hospital, 7 Chung Shan S. Road (Zhongshan S. Road), Zhongzheng Dist, Taipei, 100225, Taiwan (R.O.C.)
| | - Jeff Shih-Chieh Chueh
- Department of Urology, National Taiwan University Hospital, 7 Chung Shan S. Road (Zhongshan S. Road), Zhongzheng Dist, Taipei, 100225, Taiwan (R.O.C.)
| | - Yuan-Ju Lee
- Department of Urology, National Taiwan University Hospital, 7 Chung Shan S. Road (Zhongshan S. Road), Zhongzheng Dist, Taipei, 100225, Taiwan (R.O.C.).
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Tanidir Y, Sekerci CA, Bujons A, Castellani D, Ferretti S, Gatti C, Campobasso D, Quiroz Y, Teoh JYC, Pietropaolo A, Ragoori D, Bhatia TP, Vaddi CM, Shrestha A, Lim EJ, Fong KY, Sinha MM, Griffin S, Sarica K, Somani BK, Traxer O, Gauhar V. The Utility and Safety of Ureteral Access Sheath During Retrograde Intrarenal Surgery in Children. Urology 2024; 187:71-77. [PMID: 38432431 DOI: 10.1016/j.urology.2024.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/15/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To compare retrograde intrarenal surgery (RIRS) with and without ureteral access sheath (UAS) in different pediatric age groups. METHODS The data of RIRS for kidney stone in children were obtained from 9 institutions. Demographic characteristics of patients and stones, intraoperative and postoperative results were recorded. While analyzing the data, patients who underwent RIRS without UAS (group 1) (n = 195) and RIRS with UAS (group 2) (n = 194) were compared. RESULTS Group 1 was found to be young, thin, and short (P <.001, P = .021, P <.001), but there was no gender difference and similar symptoms were present except hematuria, which was predominant in group 2 (10.6% vs 17.3%, P <.001). Group 1 had smaller stone diameter (9.91 ± 4.46 vs 11.59 ± 4.85 mm, P = .001), shorter operation time (P = .040), less stenting (35.7% vs 72.7%, P = .003). Re-intervention rates and stone-free rates (SFR) were similar between groups (P = .5 and P = .374). However, group 1 had significantly high re-RIRS (P = .009). SFR had a positive correlation with smaller stone size and thulium fiber laser usage compared to holmium fiber laser (HFL) (P <.001 and P = .020), but multivariate analysis revealed only large stone size as a risk factor for residual fragments (P = .001). CONCLUSION RIRS can be performed safely in children with and without UAS. In children of smaller size or younger age (<5 years), limited use of UAS was observed. UAS may be of greater utility in stones larger than 1 cm, regardless of the age, and using smaller diameter UAS and ureteroscopes can decrease the complications.
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Affiliation(s)
- Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Cagri Akin Sekerci
- Division of Pediatric Urology, Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Anna Bujons
- Urology Department, Autonomous University of Barcelona, Fundació Puigvert, Barcelona, Spain.
| | - Daniele Castellani
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Università Politecnica Delle Marche, Ancona, Italy.
| | - Stefania Ferretti
- Urology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Claudia Gatti
- Pediatric Surgery Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Davide Campobasso
- Urology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
| | - Yesica Quiroz
- Urology Department, Autonomous University of Barcelona, Fundació Puigvert, Barcelona, Spain.
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China.
| | - Amelia Pietropaolo
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
| | - Deepak Ragoori
- Department of Urology, Asian Institute of Nephrology and Urology, Banjara Hills, Hyderabad, Telangana, India.
| | - Tanuj Paul Bhatia
- Department of Urology, Sarvodaya Healthcare, Faridabad, Haryana, India.
| | - Chandra Mohan Vaddi
- Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, Telangana, India.
| | - Anil Shrestha
- Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kanti Path, Kathmandu, Nepal.
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore.
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Mriganka Mani Sinha
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
| | - Stephen Griffin
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom.
| | - Kemal Sarica
- Department of Urology, Biruni University, Istanbul, Turkey.
| | - Bhaskar Kumar Somani
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
| | - Olivier Traxer
- Department of Urology Hôpital Tenon, Sorbonne University, Paris, France.
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong Hospital, Singapore, Singapore.
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Castellani D, Traxer O, Ragoori D, Galosi AB, De Stefano V, Gadzhiev N, Tanidir Y, Inoue T, Emiliani E, Hamri SB, Lakmichi MA, Vaddi CM, Heng CT, Soebhali B, More S, Sridharan V, Gökce MI, Tursunkulov AN, Ganpule A, Pirola GM, Naselli A, Aydin C, Ramón de Fata Chillón F, Mendoza CS, Candela L, Chew BH, Somani BK, Gauhar V. Improving Outcomes of Same-sitting Bilateral Flexible Ureteroscopy for Renal Stones in Real-world Practice-Lessons Learnt from Global Multicenter Experience of 1250 Patients. EUR UROL SUPPL 2023; 52:51-59. [PMID: 37284041 PMCID: PMC10240508 DOI: 10.1016/j.euros.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 06/08/2023] Open
Abstract
Background Bilateral kidney stones are commonly treated in staged procedures. Objective To evaluate outcomes after same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) for renal stones. Design setting and participants Data from adults who underwent bilateral RIRS in 21 centers were retrospectively reviewed (from January 2015 to June 2022). The inclusion criteria were unilateral/bilateral symptomatic bilateral stone(s) of any size/location in both kidneys and bilateral stones on follow-up with symptom/stone progression. Stone-free rate (SFR) was defined as absence of any fragment >3 mm at 3 mo. Outcome measurements and statistical analysis Continuous variables are presented as medians and 25-75th percentiles. A multivariable logistic regression analysis was performed to evaluate independent predictors of sepsis and bilateral SFR. Results and limitations A total of 1250 patients were included. The median age was 48.0 (36-61) yr. Of the patients, 58.2% were prestented. The median stone diameter was 10 mm on both sides. Multiple stones were present in 45.3% and 47.9% of the left and right kidneys, respectively. Surgery was stopped in 6.8% of cases. The median surgical time was 75.0 (55-90) min. Complications were transient fever (10.7%), fever/infection needing prolonged stay (5.5%), sepsis (2%), and blood transfusion (1.3%). Bilateral and unilateral SFRs were 73.0% and 17.4%, respectively. Female (odds ratio [OR] 2.97, 95% confidence interval [CI] 1.18-7.49, p = 0.02), no antibiotic prophylaxis (OR 5.99, 95% CI 2.28-15.73, p < 0.001), kidney anomalies (OR 5.91, 95% CI 1.96-17.94, p < 0.001), surgical time ≥100 min (OR 2.86, 95% CI 1.12-7.31, p = 0.03) were factors associated with sepsis. Female (OR 1.88, 95% CI 1.35-2.62, p < 0.001), bilateral prestenting (OR 2.16, 95% CI 1.16-7.66, p = 0.04), and the use of high-power holmium:YAG laser (OR 1.63, 95% CI 1.14-2.34, p < 0.01) and thulium fiber laser (OR 2.50, 95% CI 1.32-4.74, p < 0.01) were predictors of bilateral SFR. Limitations were retrospective study and no cost analysis. Conclusions SSB-RIRS is an effective treatment with an acceptable complication rate in selected patients with kidney stones. Patient summary In this large multicenter study, we looked at outcomes after same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) for renal stones in a large cohort. We found that SSB-RIRS was associated with acceptable morbidity and good stone clearance after a single session.
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Affiliation(s)
- Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Olivier Traxer
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France
| | - Deepak Ragoori
- Department of Urology, Asian Institute of Nephrology & Urology, Irram Manzil Colony, Hyderabad, Telangana, India
| | - Andrea Benedetto Galosi
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Virgilio De Stefano
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Nariman Gadzhiev
- Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia
| | - Yiloren Tanidir
- Department of Urology, School of Medicine, Marmara University, İstanbul, Turkey
| | - Takaaki Inoue
- Department of Urology, Hara Genitourinary Private Hospital, Kobe University, Kobe, Japan
| | - Esteban Emiliani
- Department of Urology, Fundacion Puigvert, Autónomos University of Barcelona, Barcelona, Spain
| | - Saeed Bin Hamri
- Division of Urology, Department of Surgery, Ministry of the National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohamed Amine Lakmichi
- Department of Urology, University Hospital Mohammed the VIth of Marrakesh, Marrakesh, Morocco
| | | | - Chin Tiong Heng
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Boyke Soebhali
- Department of Urology, Abdul Wahab Sjahranie Hospital, Medical Faculty Mulawarman University, Samarinda, Indonesia
| | - Sumit More
- Department of Urology, Sarvodaya Hospital and Research Centre, Faridabad, India
| | - Vikram Sridharan
- Department of Urology, Sree Paduka Speciality Hospital, Thillai Nagar, India
| | - Mehmet Ilker Gökce
- Department of Urology, Ankara University, School of Medicine, Ankara, Turkey
| | | | - Arvind Ganpule
- Department of Urology, Muļjibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Giacomo Maria Pirola
- Urology Department, San Giuseppe Hospital, IRCCS Multimedica, Multimedica Group, Milan, Italy
| | - Angelo Naselli
- Urology Department, San Giuseppe Hospital, IRCCS Multimedica, Multimedica Group, Milan, Italy
| | - Cemil Aydin
- Department of Urology, Hitit University, School of Medicine, Çorum, Turkey
| | | | - Catalina Solano Mendoza
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France
- Department of Endourology, Uroclin S.A.S, Medellín, Colombia
| | - Luigi Candela
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France
- Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Ben Hall Chew
- Department of Urology, University of British Columbia, Vancouver, Canada
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
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