Prospective Evaluation of Risk Factors Responsible for Infection Following Retrograde Intrarenal Surgery

OBJECTIVE

The study aimed to identify the various risk factors for infective complications following retrograde intrarenal surgery (RIRS).

MATERIALS AND METHODS

The study was conducted over one year, and the incidence of infectious complications after RIRS was calculated. Patients were divided into two groups based on the presence and absence of infective complications and were compared in terms of preoperative and operative characteristics. The complications were assessed and graded according to the Modified Clavien classification system (MCCS). The Fisher's exact test, Student's t-test, and Mann-Whitney U test were used for univariate analysis. Multivariate logistic regression analysis was used to identify independent risk factors for postoperative urinary tract infection (UTI).

RESULTS

Out of 165 patients in the study, 27 (16.7%) patients developed UTI within one month of undergoing RIRS. The most frequent complication was fever, which occurred in 13 (7.8%) patients. When stratified by MCCS, 13 were grade I, nine were grade II, four were grade III, and one was a grade IV complication. High stone burden, concomitant diabetes mellitus, and multiple renal stones were identified as substantial risk factors for postoperative UTI in univariate analysis. On multivariate analysis, preoperative UTI and prolonged operative time were found to have a significant association with postoperative UTI.

CONCLUSION

The present study demonstrated that preoperative UTI and prolonged operative time are independent factors responsible for postoperative UTI. Large stone burden, stone multiplicity, and diabetes mellitus contribute to a higher risk for UTI following RIRS.

Comparison of traditional and suctioning ureteral access sheath during retrograde intrarenal surgery in the treatment of renal calculi

PURPOSE

This study aims to compare the efficiency and clinical outcomes between the suctioning ureteral access sheath (UAS) group and the traditional UAS group during retrograde intrarenal surgery (RIRS) for kidney stones and explore the impact of suctioning UAS on postoperative infectious complications.

METHODS

We retrospectively reviewed the clinical data of 162 patients with kidney stones who underwent RIRS with a traditional UAS (n = 74) or a suctioning UAS (n = 71) between March 2021 and May 2023.

RESULTS

The mean operative time in suctioning UAS group (39.03 ± 18.01 s) was significantly shorter than that (49.73 ± 20.77 s) in the traditional UAS group (P = 0.037). The mean postoperative hospital stay was significantly shorter in the suctioning UAS group (1.57 ± 0.82d) compared with the traditional UAS group (2.30 ± 1.6 2 d) (P = 0.032). The instant SFRs were significantly higher in the suctioning UAS group (88.73%) than in the traditional UAS group (75.68%) (P = 0.040). The overall SFR in suctioning UAS group (92.96%) was slightly higher than the traditional UAS group (85.14%). The incidence of overall complications was significantly higher in the traditional UAS group (35.14%) than in the suctioning UAS group (16.90%) (P = 0.013). In multivariate analysis, female patients (OR 0.053, P = 0.018), positive urine WBC (OR 10.382, P = 0.034), operative time > 60 min (OR 20.231, P = 0.032), and the application of traditional UAS (OR 0.042, P = 0.017) were independent risk factors associated with infectious complications.

CONCLUSION

We demonstrated that suctioning UAS provided a higher instant SFR and fewer postoperative infectious complications during RIRS, and patients with predictable risk factors for infectious complications could potentially benefit from the use of the suctioning UAS.

Risk of Sepsis in Retrograde Intrarenal Surgery: A Systematic Review of the Literature

Context

Objective

Evidence acquisition

Evidence synthesis

Conclusions

Patient summary

Predictors and Healthcare Utilization of Sepsis Post-Ureteroscopy in a US-Based Population : Results from the Endourological Society TOWER Collaborative

Purpose To investigate the incidence, predictive factors, and healthcare utilization of sepsis post-ureteroscopy (URS) in patients enrolled in commercial insurance plans. Materials and Methods A retrospective claims analysis was conducted using the IBM® MarketScan® commercial database. Patients ≥18 years were included if they had URS between January 2015-October 2019 and developed sepsis within 30 days of URS. Multivariate logistic regression was used to identify various clinical and demographic predictors of sepsis post-URS. All-cause healthcare utilization (i.e., inpatient admissions and intensive care unit stays) and all-cause healthcare costs up to 1 month post-septic event were measured. Results Among the 104,100 URS patients meeting the inclusion criteria, 5.5% developed sepsis. Patients with diabetes (OR=1.52; p<0.0001), older age (age 55-64 versus 18-34; OR=1.35; p<0.0001), baseline sepsis (OR=3.51; p<0.0001), baseline inpatient visits (OR=1.17; p=0.0012), and higher Elixhauser comorbidity scores (OR=1.09; p<0.0001) had a significantly higher likelihood of developing sepsis post-URS. In septic patients, 94.8% required inpatient care and 35% were admitted to the ICU. Mean hospital stay for septic patients was 6.86 days. Average all-cause healthcare cost per patient at 1 month in the septic cohort was $49,625 versus $17,782 in the non-septic cohort indicating an incremental all-cause cost of $31,843 (p<0.0001). Conclusions A total of 5.5% of commercially insured patients undergoing URS developed sepsis post-URS. Diabetes, older age, baseline sepsis, baseline inpatient visit, and higher comorbidity score were all found to be independent predictors of post-URS sepsis. Patients with sepsis post-URS had higher healthcare utilization and costs indicating that sepsis is both a significant clinical and economic event.

Gender Differences in Kidney Stone Disease (KSD): Findings from a Systematic Review

PURPOSE OF REVIEW

The prevalence of kidney stones is rising and historically carries a preponderance for males. However, recent evidence has questioned whether this gender gap is closing. The aim of this systematic review was to examine this further as well as evaluate possible underlying causes.

RECENT FINDINGS

Recent evidence confirms the disparity in kidney stone disease between genders is closing. In the modern era, the rise in prevalence among females has been greater, especially in adolescence. Quality of life is also more adversely affected by kidney stone events among females who are also more likely to develop sepsis after endourological surgery. Males, however, are more likely to present with stone events during periods of high ambient temperatures Recent literature demonstrates a temporal change in the disease burden of KSD among men and women. The latter, especially adolescent females, are more likely to develop KSD in their lifetime compared to previous eras. Determining causation is complex and continued research is warranted.

Risk Factors for Urosepsis After Ureteroscopy for Stone Disease: A Systematic Review with Meta-Analysis

Introduction: Urosepsis is a serious potential complication of ureteroscopic procedures for stone disease, yet the risk factors for this complication are not well characterized. The purpose of this systematic review with meta-analysis was to identify potential risk factors for urosepsis after ureteroscopy (URS) for stone disease. Materials and Methods: We performed systematic searches of Medline, Embase, and the Cochrane Central Register of Controlled Trials for studies reporting at least one prospectively defined risk factor for urosepsis after URS. Studies that only reported rates of isolated fever, urinary tract infection (UTI), or pooled infectious complications were excluded. The risk factors evaluated in this review were age, sex, body mass index, diabetes mellitus, ischemic heart disease, recent UTI, pyuria, hydronephrosis, stone history, stone size, preoperative stent placement, preoperative positive urine culture, and procedure time. A random effects meta-analysis model with inverse variance weighting was used where the statistic of interest was the odds ratio for dichotomous variables and the mean difference for continuous outcomes. Results: In 13 studies (5 prospective) with 5597 patients, the pooled incidence of postoperative urosepsis was 5.0% (95% confidence interval: 2.4-8.2). Six risk factors were statistically associated with increased postoperative urosepsis risk-preoperative stent placement (odds ratio = 3.94, p < 0.001, 6 studies), positive preoperative urine culture (odds ratio = 3.56, p < 0.001, 6 studies), ischemic heart disease (odds ratio = 2.49, p = 0.002, 2 studies), older age (mean difference = 2.7 years, p = 0.002, 6 studies), longer procedure time (mean difference = 9 minutes, p = 0.02, 1 study), and diabetes mellitus (odds ratio = 2.04, p = 0.04, 6 studies). Conclusions: Current evidence suggests that among patients undergoing URS for treatment of stone disease, the risk of postoperative urosepsis was 5.0%. Older age, diabetes mellitus, ischemic heart disease, preoperative stent placement, a positive urine culture, and longer procedure time were associated with increased postoperative urosepsis risk. These results will assist urologists with preoperative risk stratification before ureteroscopic procedures.