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Bapir R, Bhatti KH, Eliwa A, García-Perdomo HA, Gherabi N, Hennessey D, Mourmouris P, Ouattara A, Perletti G, Philipraj J, Trinchieri A, Buchholz N. Infectious complications of endourological treatment of kidney stones: A meta-analysis of randomized clinical trials. Arch Ital Urol Androl 2022; 94:97-106. [PMID: 35352534 DOI: 10.4081/aiua.2022.1.97] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Endourological treatment is associated with a risk of postoperative febrile urinary tract infections and sepsis. The aim of this study was to review the reported rate of infectious complications in relation to the type and modality of the endourologic procedure. METHODS This systematic review was conducted in accordance with the PRISMA guidelines. Two electronic databases (PubMed and EMBASE) were searched. Out of 243 articles retrieved we included 49 studies after full-text evaluation. RESULTS Random-effects meta-analysis demonstrated that retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) were associated with not significantly different odds of getting fever (OR = 1.54, 95% CI: 0.99 to 2.39; p = 0.06) or sepsis (OR = 1.52, 95% CI: 0.37 to 6.20, p = 0.56). The odds of getting fever were not significantly different for mini PCNL compared to standard PCNL (OR = 1.11, 95% CI: 0.85 to 1.44; p = 0.45) and for tubeless PCNL compared to standard PCNL (OR = 1.34 95% CI: 0.61 to 2.91, p = 0.47). However, the odds for fever after PCNL with suctioning sheath were lower than the corresponding odds for standard PCNL (OR = 0.37, 95% CI: 0.20 to 0.70, p = 0.002). The odds of getting fever after PCNL with perioperative prophylaxis were not different from the corresponding odds after PCNL with perioperative prophylaxis plus a short oral antibiotic course (before or after the procedure) (OR = 1.31, 95% CI: 0.71 to 2.39, p = 0.38). CONCLUSIONS The type of endourological procedure does not appear to be decisive in the onset of infectious complications, although the prevention of high intrarenal pressure during the procedure could be crucial in defining the risk of infectious complications. on behalf of U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai.
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Affiliation(s)
- Rawa Bapir
- Smart Health Tower, Sulaymaniyah, Kurdistan region.
| | | | - Ahmed Eliwa
- Department of Urology, Zagazig University, Zagazig, Sharkia.
| | | | | | | | - Panagiotis Mourmouris
- 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanoglio Hospital, Athens.
| | - Adama Ouattara
- Division of Urology, Souro Sanou University Teaching Hospital, Bobo-Dioulasso.
| | - Gianpaolo Perletti
- Department of Biotechnology and Life Sciences, Section of Medical and Surgical Sciences, University of Insubria, Varese, Italy; Faculty of Medicine and Medical Sciences, Ghent University.
| | - Joseph Philipraj
- Department of Urology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry.
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Başataç C, Özman O, Cakir H, Çinar Ö, Akgül HM, Siddikoglu D, Sancak EBB, Yazici CM, Baseskioglu B, Onal B, Akpinar H. Retrograde intrarenal surgery is a safe procedure in severe obese patients. Is it reality or prediction? A propensity score-matching analysis from RIRSearch study group. J Endourol 2022; 36:891-897. [PMID: 35029126 DOI: 10.1089/end.2021.0887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The aim of the study was to assess whether severely obese patients have an increased risk of complications during and after retrograde intrarenal surgery. MATERIALS AND METHODS The data of 639 consecutive patients undergoing retrograde intrarenal surgery for the treatment of upper tract urinary stones were analyzed retrospectively. The patients were divided into two groups according to their body mass index numbers (Group 1, <35; Group 2, ≥35). The patients' demographics, stone characteristics, operative outcomes, and complication rates were compared between the groups. The primary objective was to examine whether the intraoperative and postoperative complication rates were higher in patients with a body mass index of ≥35 kg/m2. RESULTS After matching of confounding factors, Group 1 comprised 135 patients, and Group 2 comprised 47 patients. The baseline characteristics were similar between the groups. There were no significant differences between groups for intraoperative complication rates (11.8% and 12.8%, respectively; p=0.97). There was statistically significant difference in favor of Group 2 for postoperative complication rates (12.6% and 29.7%; respectively, p<0.01), overall complication rates (22.9% and 38.2%; respectively, p=0.02), mean operation time (56.15 minute vs 66.45 minute; respectively, p= 0.01) and length of stay (1.4 days vs 2.1 days; p=0.03). Stone free rates (75.5% vs 85.1%; respectively, p=0.17) did not differ between groups. CONCLUSIONS Retrograde intrarenal surgery is an efficient and feasible treatment option for upper urinary tract stones in severe obese patients. However, higher possibility of postoperative, especially infectious, complication rates should be taken into account in these patients.
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Affiliation(s)
- Cem Başataç
- Group Florence Nightingale Hospitals, 74833, Department of Urology, Istanbul, Turkey;
| | - Oktay Özman
- Gaziosmanpaşa Taksim Eğitim ve Araştırma Hastanesi, 147020, Urology Clinic, Gaziosmanpaşa, Istanbul, Turkey, 34000;
| | - Hakan Cakir
- Acibadem Hospitals Group, 64296, Acibadem Fulya Hospital Clinic of Urology Istanbul/Turkey, Istanbul, Turkey;
| | - Önder Çinar
- Bulent Ecevit University , Urology, Kozlu/Zonguldak, Zonguldak, Turkey, 67600;
| | - Hacı Murat Akgül
- Tekirdag Namik Kemal University, Urology, Tekirdag Namik Kemal University Urology Department, tekirdag, Turkey, 59010;
| | | | | | - Cenk Murat Yazici
- Namik Kemal University, Department of Urology, Namik Kemal University Hospital, Deparment of Urology, Tekirdag, Turkey, 59000;
| | - Barbaros Baseskioglu
- Acibadem Hospitals Group, 64296, Acibadem Hospital Clinic of Urology, Eskişehir, Turkey;
| | - Bulent Onal
- Istanbul University- Cerrahpasa, Cerrahpasa School of Medicine, Department of Urology, Istanbul, Turkey;
| | - Haluk Akpinar
- Group Florence Nightingale Hospitals, 74833, Department of Urology, Istanbul, Turkey;
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Dybowski B, Bres-Niewada E, Rzeszutko M, Tkaczyk A, Woźniak B, Wójcik M, Znajdek Z. Risk factors for infectious complications after retrograde intrarenal surgery - a systematic review and narrative synthesis. Cent European J Urol 2021; 74:437-445. [PMID: 34729234 PMCID: PMC8552946 DOI: 10.5173/ceju.2021.250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 01/03/2023] Open
Abstract
Introduction Infectious complications are among the most frequent and significant complications in retrograde intrarenal lithotripsy. To date, review articles have covered complications after a ureteroscopy, but not after retrograde intrarenal surgery (RIRS), specifically. Because the complications and risk factors are different for a ureteroscopy and RIRS, we aimed to identify variables related to the occurrence of infectious complications post-RIRS. Material and methods This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. We included original studies that described 100 or more procedures published in 2014–2021. We extracted data and performed a narrative synthesis to explore and interpret differences between the studies. Results We selected 17 studies for analysis, including 10 from 2019–2021. Infectious complications after RIRS were observed in 2.8–7.5% of patients (mean 7.1%). We found seven independent risk factors associated with infectious complications after RIRS: long operative time, recent history of positive urine culture or urinary tract infection or antibiotic use, pyuria/nitrites, small caliber of ureteral access sheath, struvite stone, high irrigation rate, and comorbidities. Conclusions If an increased rate of infectious complications is found at a RIRS center, countermeasures should include restrictions on operative time and irrigation rate, and consideration of larger access sheaths, especially for patients with abnormal urine results or with struvite stones or with a history of urinary tract infection or co-morbidities.
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Affiliation(s)
- Bartosz Dybowski
- Department of Urology, Roefler Memorial Hospital, Pruszków, Poland.,Faculty of Medicine, Lazarski University, Warsaw, Poland
| | - Ewa Bres-Niewada
- Department of Urology, Roefler Memorial Hospital, Pruszków, Poland.,Faculty of Medicine, Lazarski University, Warsaw, Poland
| | | | | | - Barbara Woźniak
- Department of Urology, Roefler Memorial Hospital, Pruszków, Poland
| | - Marta Wójcik
- Department of Urology, Roefler Memorial Hospital, Pruszków, Poland
| | - Zuzanna Znajdek
- Department of Urology, Roefler Memorial Hospital, Pruszków, Poland
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