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Veeratterapillay R, Gravestock P, Harding C, Shaw M, Fitzpatrick J, Keltie K, Cognigni P, Sims A, Rogers A. Infection after ureteroscopy for ureteric stones: analysis of 71 305 cases in the Hospital Episode Statistics database. BJU Int 2023; 131:109-115. [PMID: 35844154 DOI: 10.1111/bju.15850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To investigate the burden of infectious complications following ureteroscopy (URS) for ureteric stones on a national level in England using data from the Hospital Episodes Statistics (HES) data warehouse. MATERIALS AND METHODS A retrospective cohort was identified and followed up in HES during the period April 2013 to March 2020 for all procedure codes relating to ureteroscopic stone treatment (M27.1, M27.2, M27.3). Treatment episodes relating to the first URS ('index ureteroscopy') for each patient were further analysed. All subsequent admissions within 30 days were also captured. The primary outcome was diagnosis of urinary tract infection (UTI; including all codes relating to a UTI/sepsis within the first 30 days of index URS). Secondary outcomes were critical care attendance, attendance at the accident and emergency department (A&E) within 30 days, and mortality. RESULTS A total of 71 305 index ureteroscopies were eligible for analysis. The median age was 55 years, and 81% of procedures were elective and 45% were undertaken as day-cases. At the time of index URS, 16% of patients had diabetes, 0.5% had coexisting neurological disease and 40% had an existing stent/nephrostomy. Overall, 6.8% of the cohort (n = 4822) had a diagnosis of UTI within 30 days of index URS (3.9% immediately after surgery). A total of 339 patients (0.5%) required an unplanned stay in critical care during their index URS admission; 8833 patients (12%) attended A&E within 30 days. Overall mortality was 0.18% (60 in-hospital, 65 within 30 days); 40 deaths (0.056%) included infection as a contributing cause of death. CONCLUSION We present the largest series evaluating infectious complications after ureteroscopic stone treatment. The procedure is safe, with low inpatient infective complication and critical care admission rates.
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Affiliation(s)
| | - Paul Gravestock
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Chris Harding
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Matthew Shaw
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John Fitzpatrick
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Kim Keltie
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Faculty of Medical Sciences, Translational and Clinical Research Institute, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Paola Cognigni
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Andrew Sims
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Faculty of Medical Sciences, Translational and Clinical Research Institute, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Alistair Rogers
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Tzelves L, Chatzikrachtis N, Lazarou L, Mourmouris P, Pinitas A, Tsirkas K, Petropoulos O, Berdempes M, Feretzakis G, Glykas I, Fragkoulis C, Varkarakis I, Skolarikos A. Fragility index of urological literature regarding medical expulsive treatment. World J Urol 2021; 39:3741-3746. [PMID: 33978811 DOI: 10.1007/s00345-021-03725-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/03/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The role of medical expulsive treatment (MET) is controversial. Fragility index is an additional metric to assess randomized controlled trials (RCTs) outcome validity and indicates how many patients would be required to convert a trial from being statistically significant, to not significant. The larger is the FI, the better the trial's data. The aim of this study is to assess FI of RCTs regarding MET for ureteral stones. MATERIALS AND METHODS A systematic literature search was performed. RCTs, reporting stone expulsion as a dichotomous outcome, showing statistical significance were eligible. FI (the number of patients needed to change from a non-event to event group, to lose statistical significance) and Fragility quotient (FI divided by total sample size), were calculated while Pearson's correlation and Mann-Whitney U test were used as appropriate. RESULTS Thirty-six RCTs were eligible, with median FI = 3.5 and fragility quotient = 0.042, median sample size = 81, median journal impact factor = 1.73 and median reported p value = 0.008. In 33.3% of the studies, number of patients lost during follow-up was larger than FI, while in 13.89% of the studies, FI was 0, indicating use of inappropriate statistical method. Pearson's correlation showed significant positive association between FI and sample size (r = 0.981), number of events (r = 0.982) and impact factor (r = 0.731), while no association was found with p value or publication year. CONCLUSIONS In this analysis, a calculated FI of 3.5 indicates that findings from RCTs on MET for ureteral stones are fragile and should be interpreted in combination with clinical thinking and expertise.
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Affiliation(s)
- Lazaros Tzelves
- Second Department of Urology, Sismanogleio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Chatzikrachtis
- Second Department of Urology, Sismanogleio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Lazaros Lazarou
- Second Department of Urology, Sismanogleio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Mourmouris
- Second Department of Urology, Sismanogleio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Pinitas
- Second Department of Urology, Sismanogleio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kimon Tsirkas
- Second Department of Urology, Sismanogleio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Orestis Petropoulos
- Second Department of Urology, Sismanogleio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marinos Berdempes
- Second Department of Urology, Sismanogleio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Feretzakis
- Department of Quality Control, Research and Continuing Education, Sismanogleio General Hospital, 15126, Marousi, Greece
| | - Ioannis Glykas
- Department of Urology, General Hospital of Athens "G. Gennimatas", Athens, Greece.
| | | | - Ioannis Varkarakis
- Second Department of Urology, Sismanogleio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Skolarikos
- Second Department of Urology, Sismanogleio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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