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Tasaka S, Kohada Y, Ikeda M, Kanaoka R, Hayashi M, Hinata N. Utility of the modified 5-item frailty index as a predictor of postoperative febrile urinary tract infection in patients who underwent ureteroscopy with laser lithotripsy. World J Urol 2024; 42:323. [PMID: 38748255 PMCID: PMC11096205 DOI: 10.1007/s00345-024-05016-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
PURPOSE This study aimed to assess the effect of the modified 5-item frailty index on perioperative complications and surgical outcomes in patients who underwent ureteroscopy with laser lithotripsy for upper urinary tract stones. METHODS Patients who underwent ureteroscopy with laser lithotripsy for upper urinary tract stones between 2019 and 2022 were reviewed retrospectively. Assessment was performed using the modified 5-item frailty index based on medical history (hypertension, diabetes, heart failure, chronic obstructive pulmonary disease) and functional status. Patients were categorized into the high (≥ 2) and low (≤ 1) modified 5-item frailty index groups based on the frailty score. We compared the perioperative complications and surgical outcomes between the two groups. RESULTS Seventy-one (15.8%) and 393 (84.1%) of the 467 patients were classified into the high and low modified 5-item frailty index groups, respectively. The high modified 5-item frailty index group exhibited a significant association with increased febrile urinary tract infections compared to the low modified 5-item frailty index group [≥ 37.8 °C: 15 (20.3%) vs 13 (3.3%), p < 0.001; ≥ 38 °C: 9 (12.2%) vs 7 (1.8%), p < 0.001]. Surgical outcomes, including operative time and stone-free rate, did not differ significantly between the two groups. CONCLUSION The modified 5-item frailty index is valuable for predicting postoperative complications, particularly febrile urinary tract infections, after ureteroscopy with laser lithotripsy for upper urinary tract stones. This index allows for practical preoperative risk assessment in patients who underwent ureteroscopy with laser lithotripsy.
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Affiliation(s)
- Shinsaku Tasaka
- Department of Urology, Takanobashi Central Hospital, Hiroshima, Japan
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Yuki Kohada
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | - Mikio Ikeda
- Department of Urology, Takanobashi Central Hospital, Hiroshima, Japan
| | - Ryuhei Kanaoka
- Department of Urology, Takanobashi Central Hospital, Hiroshima, Japan
| | - Mutsuo Hayashi
- Department of Urology, Takanobashi Central Hospital, Hiroshima, Japan
| | - Nobuyuki Hinata
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
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Raynal G, Malval B, Panthier F, Roustan FR, Traxer O, Meria P, Almeras C. 2022 Recommendations of the AFU Lithiasis Committee: Ureteroscopy and ureterorenoscopy. Prog Urol 2023; 33:843-853. [PMID: 37918983 DOI: 10.1016/j.purol.2023.08.016] [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: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
Technical advances, including miniaturization, have improved the deflection and optical performance of the ureteroscopes, and the availability of dedicated disposable devices have led to their increasing use for kidney and ureteral stone management. Ureterorenoscopy brings diagnostic evidence through the endoscopic description of stones and renal papillary abnormalities. Currently, intracorporeal lithotripsy during ureterorenoscopy is based on laser sources. Routine ureteral stenting is not necessary before ureterorenoscopy, especially because preoperative stenting for>30 days is considered as an independent risk factor of infection. Ureteral access sheaths allow the easy and repeated access to the upper urinary tract and thus facilitate ureterorenoscopy. Their use improves vision, decreases intrarenal pressure, and possibly reduces the operative time, but they may cause ureteral injury. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether or not the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis [EAU 2022]) and their adaptability to the French context.
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Affiliation(s)
- G Raynal
- Department of urology, clinique Métivet, 48, rue d'Alsace Lorraine, 94100 Saint-Maur-des-Fossés, France
| | - B Malval
- Clinique Saint-Hilaire, Rouen, France
| | - F Panthier
- GRC lithiase, AP-HP, Sorbonne université, Paris, France; Laboratoire PIMM, Arts et Métiers Paris Tech, Paris, France
| | | | - O Traxer
- GRC lithiase, AP-HP, Sorbonne université, Paris, France; Laboratoire PIMM, Arts et Métiers Paris Tech, Paris, France
| | - P Meria
- Service d'urologie, hôpital Saint-Louis, AP-HP-centre université Paris Cité, Paris, France
| | - C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
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Méndez‐Guerrero DM, Buitrago‐Carrascal C, Puentes‐Bernal AF, Cruz‐Arévalo DA, Camacho ‐Nieto D, Calderón MA, Álvarez‐Restrepo JC, Brijaldo‐Carvajal MA, Perdomo‐Bernal N, Moreno‐Matson MC, Ibañez‐Pinilla M, Daza‐Vergara J. Antibiotic prophylaxis in flexible ureterorenoscopy with negative urine culture. BJUI COMPASS 2023; 4:688-694. [PMID: 37818028 PMCID: PMC10560613 DOI: 10.1002/bco2.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/05/2023] [Accepted: 03/19/2023] [Indexed: 10/12/2023] Open
Abstract
Objective To improve susceptibility profiles of nosocomial bacteria, identifying the difference between infectious complications in patients undergoing endoscopic flexible ureterolithotomy (fURS) with negative urine culture (UC) that received extended antibiotic prophylaxis (EP) compared with standard antibiotic prophylaxis (SP). Methodology This is a retrospective, observational, analytical cohort study, comparing infectious complications between patients undergoing fURS with negative UC who received EP versus SP. We include patients with susccessfull fURS, <20-mm stones and complete information. Results Overall, 10.3% of patients had complications, 7.2% of patients had postoperative urinary infection, 1.8% had upper urinary tract infection (UTI) and 1.4% had urinary sepsis. Lower UTI were significantly more likely in the extended prophylaxis group with 6.8% versus 2.7% (RR = 2.8; 95% CI: 1.10-7.37, p = 0.030). The risk of upper UTI and sepsis did not show significant differences. A total of 69% patients with postoperative infection had isolated multidrug-resistant bacteria (MDRB) in the UC, with a higher risk in patients with extended prophylaxis (RR = 3.1; 95% CI: 1.33-7.59, p = 0.009). Conclusions Patients with negative UC who underwent fURS using extended prophylaxis have two times higher risk of low UTI than patients with standard prophylaxis, without differences in the incidence of upper UTI or urinary sepsis. The risk of MDRB isolation in the postoperative UC is higher in the extended prophylaxis group, therefore we recommend the standard 60-min preoperative prophylaxis.
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Affiliation(s)
| | | | | | | | - Diego Camacho ‐Nieto
- Department of UrologyHospital Universitario Mayor Méderi ‐ Universidad del RosarioBogotáColombia
| | | | | | | | | | | | | | - José Daza‐Vergara
- Hospital Universitario Mayor Méderi ‐ Universidad del RosarioBogotáColombia
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Keten T, Balcı M, Eroğlu Ü, Özercan AY, Coşer Ş, Başboğa S, Tatlıcı K, Erkan A, Şenel Ç, Salar R, Güzel Ö, Aslan Y, Tuncel A, Atan A. Selection for antimicrobial prophylaxis in emergency and elective transurethral procedures: Susceptibility pattern in Türkiye. ULUS TRAVMA ACIL CER 2023; 29:1032-1038. [PMID: 37681729 PMCID: PMC10560822 DOI: 10.14744/tjtes.2023.99663] [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: 06/15/2023] [Revised: 07/26/2023] [Accepted: 08/04/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND In this study, we aimed to determine the most appropriate antimicrobial agents for prophylactic antibiotic use during emergency and elective transurethral procedures. METHODS The study was conducted in five hospitals located in five different geographical regions of Türkiye. The microorganism cultured in urine before emergency and elective transurethral procedures in these centers between March 2021 and March 2022 were reviewed retrospectively from the hospital records. Demographic data (age and gender) of the patients, comorbid disorders, previous urological procedures, anomalies of the urogenital tract, use of urethral catheters (permanent or clean intermittent catheterization), cultured microorganisms, and antibiotic susceptibilities were noted. The patients hospitalized or had antibiotics for any reason in the previous 1 month were excluded from the study. RESULTS A total of 1450 patients, 742 men (51.2%) and 708 women (48.8%), were included in the study. The mean age of the patients was 55.3±19.36 (1-98) years. Diabetes mellitus was evident in 271 (18.7%) patients. The five most common microorgan-isms cultured in urine, in order of frequency, were: ESBL (-) Escherichia coli in 418 (28.8%), ESBL (+) E. coli in 309 (21.3%), Klebsiella pneumonia in 183 (12.6%), Enterococcus faecalis in 124 (8.6%), and Pseudomonas aeruginosa in 89 (6.1%). The susceptibility rates to antimicrobial agents recommended for prophylaxis by the American Urology Association and the European Association of Urology guidelines were found as follows: cefepime 87.1%, ampicillin+sulbactam 84%, TMP-SMX 71.6%, amoxicillin+clavulanate 63.5%, cefoxitin 59%, ceftazidime 58.6%, cefuroxime 43.5%, ceftriaxone 43%, and cefixime 38.4%. CONCLUSION We found that currently recommended antimicrobials provide poor coverage for the most common pathogens isolated. Urologists should consider patient-based antibiotic prophylaxis in endoscopic urethral procedures, follow appropriate proto-cols, and consider local antibiotic resistance.
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Affiliation(s)
- Tanju Keten
- Department of Urology, University of Health Sciences, School of Medicine, Ankara Bilkent City Hospital, Ankara-Türkiye
| | - Melih Balcı
- Department of Urology, Uskudar University School of Medicine, İstanbul-Türkiye
| | - Ünsal Eroğlu
- Department of Urology, University of Health Sciences, School of Medicine, Ankara Bilkent City Hospital, Ankara-Türkiye
| | - Ali Yasin Özercan
- Department of Urology, University of Health Sciences, School of Medicine, Ankara Bilkent City Hospital, Ankara-Türkiye
| | - Şeref Coşer
- Department of Urology, University of Health Sciences, School of Medicine, Ankara Bilkent City Hospital, Ankara-Türkiye
| | - Serdar Başboğa
- Department of Urology, University of Health Sciences, School of Medicine, Ankara Bilkent City Hospital, Ankara-Türkiye
| | - Koray Tatlıcı
- Department of Urology, University of Health Sciences, School of Medicine, Ankara Bilkent City Hospital, Ankara-Türkiye
| | - Anıl Erkan
- Department of Urology, Bursa Yüksek İhtisas Education and Training Hospital, Bursa-Türkiye
| | - Çağdaş Şenel
- Department of Urology, Balıkesir University School of Medicine, Balıkesir-Türkiye
| | - Remzi Salar
- Department of Urology, Şanlıurfa Mehmet Akif İnan Training and Research Hospital, Şanlıurfa-Türkiye
| | - Özer Güzel
- Department of Urology, University of Health Sciences, School of Medicine, Ankara Bilkent City Hospital, Ankara-Türkiye
| | - Yılmaz Aslan
- Department of Urology, Uskudar University School of Medicine, İstanbul-Türkiye
| | - Altuğ Tuncel
- Department of Urology, University of Health Sciences, School of Medicine, Ankara Bilkent City Hospital, Ankara-Türkiye
| | - Ali Atan
- Department of Urology, Gazi University School of Medicine, Ankara,-Türkiye
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Owa S, Hattori Y, Yonemura S, Sakurai M. A case of urinary calculus in a patient with Ehlers‐Danlos syndrome. IJU Case Rep 2023. [DOI: 10.1002/iju5.12587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Affiliation(s)
- Shunsuke Owa
- Department of Urology Matsusaka Municipal Hospital Matsusaka Mie Japan
| | - Yuna Hattori
- Department of Urology Matsusaka Municipal Hospital Matsusaka Mie Japan
| | | | - Masaki Sakurai
- Department of Urology Matsusaka Municipal Hospital Matsusaka Mie Japan
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El-Agamy ESI, Elhelaly MA, Abouelgreed TA, Abdrabuh AM, Elebiary MF, Elatreisy A, Ghoneimy OM, Fathi BA, Zamra M, Kutub K. Randomized comparison of effect of standard antibiotic prophylaxis versus enhanced prophylactic measures on rate of urinary tract infection after flexible ureteroscopy. Arch Ital Urol Androl 2023; 95:11084. [PMID: 36924374 DOI: 10.4081/aiua.2023.11084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/22/2023] [Indexed: 03/17/2023] Open
Abstract
PURPOSE To compare the rate of post-flexible ureteroscopy urinary tract infection (UTI) in patients subjected to the standard antibiotic prophylaxis alone versus enhanced prophylactic measures. METHODS A prospective randomized controlled study included 256 patients subjected to flexible ureteroscopy (FURS) for ureteral or renal stones from March 2018 to July 2022. Treatment groups included the standard antibiotic prophylaxis group (group 1, n=128) and the enhanced prophylaxis group (group 2, n=128). Patients in group 1 were injected with intravenous fluoroquinolone one hour preoperatively, and oral antibiotics were used for 24 h postoperatively. Patients in group 2 had urine culture ten days before the procedure; antibiotic-culture based was given for positive asymptomatic cases, while the procedure was deferred for active UTI. RESULTS The study groups were comparable regarding patient demographics, stone characteristics, operative time, and intraoperative complications. The overall hospitalization time was 1.68 ± 0.81 days. Postoperative, and overall complications were significantly higher in group 1 (15.6% vs. 6.3%, p = 0.04 and 26.6% vs. 17.2%, p = 0.047), respectively. Twenty patients (15.6 %) in the standard prophylaxis group were diagnosed with UTI in comparison to 8 patients (6.3 %) in the enhanced prophylaxis group (p = 0.047). CONCLUSIONS Urinary tract infection after FURS could be reduced significantly by utilizing the suggested enhanced prophylactic approach.
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Affiliation(s)
- El-Sayed I El-Agamy
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo; Department of Urology, Armed Forced Hospital, Alhada, KSA.
| | - Mohamed A Elhelaly
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo; Department of Urology, Armed Forced Hospital, Alhada, KSA.
| | - Tamer A Abouelgreed
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo; Gulf Medical University, UAE.
| | | | | | - Adel Elatreisy
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Osama M Ghoneimy
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Basem A Fathi
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | | | - Khalid Kutub
- Department of Urology, Al Aharq Jospital, Fujairah.
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Within State Variability of Antimicrobial Susceptibility: Missouri as an Archetype to Assess Guidelines for Antimicrobial Prophylaxis for Transurethral Procedures. Urology 2023:S0090-4295(23)00187-5. [PMID: 36858319 DOI: 10.1016/j.urology.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/17/2023] [Accepted: 02/12/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE To evaluate variability among hospitals in susceptibility of common uropathogens to antimicrobial agents frequently used in transurethral procedures in order to examine whether state-based guidelines might be more appropriate than national prophylactic guidelines. METHODS Hospital-level antibiograms were requested from all hospitals throughout the state of Missouri. We studied Escherichia coli, Klebsiella, and Proteus sensitivities to evaluate common guideline recommended antimicrobials including trimethoprim sulfamethoxazole (TMP-SMX), 3rd generation cephalosporins, cefazolin, penicillin combinations, gentamicin and fluoroquinolones. We evaluated variability and association between hospital characteristics and antimicrobial sensitivities. RESULTS Data was requested from 81 hospitals across the state and 38 provided the requested data (47% response rate). Susceptibility was highest for 3rd generation cephalosporins for E coli (mean of 94%), Proteus (96%), and Klebsiella (96%). Gentamicin also had high susceptibility for the bacteria studied; 94% for E coli and 96% for Klebsiella. Current first line recommended agents showed more modest coverage for E coli (cefazolin 84%, TMP-SMX 78%), Proteus (cefazolin 82%, TMP-SMX 71%), and Klebsiella (cefazolin 90%, TMP-SMX 89%). CONCLUSION Post transurethral procedure infections are common. Rates can be limited with appropriate prophylaxis. Deciding on empirical coverage must take into account local resistance patterns. There is substantial variability among and within states in antimicrobial susceptibility for common uropathogens. When selecting antimicrobial prophylaxis, urologists should consider local- rather than state- or nation-level antibiograms, given the considerable variability. Future studies should consider the merits of very-broad spectrum prophylaxis and the potential role of molecular urinary pathogen (and pathogen-resistance) testing when selecting an optimal regimen.
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Nomogram for predicting risk factors of fever in patients with negative preoperative urine culture after retrograde intrarenal surgery. World J Urol 2023; 41:783-789. [PMID: 36773093 DOI: 10.1007/s00345-023-04302-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 01/17/2023] [Indexed: 02/12/2023] Open
Abstract
PURPOSE To determine the risk factors for postoperative fever after retrograde intrarenal surgery (RIRS) in patients with negative preoperative urine culture (UC), and to establish a nomogram for predicting postoperative fever based on these risk factors. METHODS This study collected 322 patients with negative UC who received RIRS at the First Affiliated Hospital of Anhui Medical University from March 2019 to May 2022. The study population was divided into a fever group and a non-fever group. The risk factors of postoperative fever were determined by univariate and multivariate logistic regression analyses, and a nomogram was established. The nomogram was evaluated in terms of differentiation, calibration, and clinical practicability. RESULTS In this study, 47 (14.6%) patients developed a fever after surgery. Multivariate logistic regression analysis showed that for patients with negative preoperative urine culture, urinary leucocyte esterase (P = 0.005), operative time (P = 0.019), and intraoperative hypotension (P = 0.028) were independent risk factors of postoperative fever, and a nomogram was constructed according to the above variables. The area under the curve (AUC) calculated by receiver operating characteristic (ROC) analysis was 0.807 (95% CI 0.739-0.876), indicating good discrimination. The calibration curves showed good consistency, and the clinical decision curve analysis (DCA) showed the clinical applicability of the model. CONCLUSIONS For patients with negative preoperative urine culture, urine leukocyte esterase, operative time, and intraoperative hypotension are independent risk factors of postoperative fever. The new nomogram can better assess the risk of infection in patients with negative UC after RIRS.
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Gauhar V, Chai CA, Chew BH, Singh A, Castellani D, Tailly T, Emiliani E, Keat WOL, Ragoori D, Lakmichi MA, Teoh JYC, Traxer O, Somani BK. RIRS with disposable or reusable scopes: does it make a difference? Results from the multicenter FLEXOR study. Ther Adv Urol 2023; 15:17562872231158072. [PMID: 36923302 PMCID: PMC10009018 DOI: 10.1177/17562872231158072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/31/2023] [Indexed: 03/16/2023] Open
Abstract
Introduction With several single-use ureteroscopes now available, our aim was to analyze and compare data obtained globally from high-volume centers using both disposable and reusable flexible ureteroscopes and see if indeed in real-world practice either scope has a distinct advantage. Methods Retrospective analysis was performed on the FLEXOR registry, which was created as a TOWER group (Team of Worldwide Endourological Researchers, research wing of the Endourological Society) endeavor. Patients who underwent retrograde intrarenal surgery (RIRS) for renal stones from January 2018 to August 2021 were enrolled from 20 centers globally. A total of 6663 patients whose data were available for analysis were divided into Group 1 (Reusable scopes, 4808 patients) versus Group 2 (Disposable scopes, 1855 patients). Results The age and gender distribution were similar in both groups. The mean stone size was 11.8 mm and 9.6 mm in Groups 2 and 1, respectively (p < 0.001). Group 2 had more patients with >2 cm stones, lower pole stones and of higher Hounsfield unit. Thulium fiber laser (TFL) was used more in Group 2 (p < 0.001). Patients in Group 2 had a slightly higher stone-free rate (SFR) (78.22%) and a lower number of residual fragments (RFs) compared with Group 1 (p < 0.001). The need for further treatments for RF and overall complications was comparable between groups. On multivariate analysis, overall complications were more likely to occur in elderly patients, larger stone size, lower pole stones, and were also more when using disposable scopes with longer operative time. RFs were significantly higher (p < 0.001) for lower pole, larger, harder, multiple stones and in elderly. Conclusion Our real-world practice observations suggest that urologists choose disposable scopes for bigger, lower pole, and harder stones, and it does indeed help in improving the single-stage SFR if used correctly, with the appropriate lasers and lasing techniques in expert hands.
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Affiliation(s)
- Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore
| | - Chu Ann Chai
- Urology Unit, Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Ben H Chew
- Department of Urology, University of British Columbia, Vancouver, BC, Canada
| | | | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Thomas Tailly
- Department of Urology, University Hospital of Ghent, Ghent, Belgium
| | - Esteban Emiliani
- Urology Department, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | | | - Mohamed Amine Lakmichi
- Department of Urology, University Hospital Mohammed the VIth of Marrakesh, Marrakesh, Morocco
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Olivier Traxer
- Department of Urology, AP-HP, Tenon Hospital, Sorbonne University, Paris, France
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
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Assessing health literacy and subsequent implementation of an animated video to enhance understanding for patients with nephrolithiasis. Curr Urol 2022. [DOI: 10.1097/cu9.0000000000000172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Low Body Mass Index as a Predictive Factor for Postoperative Infectious Complications after Ureterorenoscopic Lithotripsy. ACTA ACUST UNITED AC 2021; 57:medicina57101100. [PMID: 34684137 PMCID: PMC8538491 DOI: 10.3390/medicina57101100] [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] [Received: 09/27/2021] [Revised: 10/11/2021] [Accepted: 10/11/2021] [Indexed: 11/17/2022]
Abstract
Background and Objectives: In this study, we aimed to evaluate predictive factors of postoperative fever (POF) after ureterorenoscopic lithotripsy (URSL). Materials and Methods: A total of 594 consecutive patients who underwent URSL for urinary stone disease at Gifu Municipal Hospital and Chuno Kosei Hospital between April 2016 and January 2021 were enrolled in this study. In all patients, antibiotics were routinely administered intraoperatively and the next day after surgery. We used rigid and/or flexible ureterorenoscopes depending on the stone location for URSL. Stones were fragmented using a holmium: YAG laser. The fragments of the stone were manually removed as much as possible using a stone basket catheter. A ureteral stent was placed at the end of the surgery in all cases. Results: The median age and body mass index (BMI) in all patients were 62 years and 23.8 kg/m2, respectively. The median operation duration was 52 min. The most common URSL-related complication was POF in 28 (4.7%) patients. In these patients, the rates of antibiotic administration and ureteral stent insertion before surgery were significantly higher than in those without POF. In multivariate analysis, BMI was associated with POF after URSL. There were no significant differences in predicting POF after surgery in patients who had bacteriuria or received antibiotics before surgery. Conclusions: A low BMI was significantly associated with POF after URS or URSL.
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Khusid JA, Hordines JC, Sadiq AS, Atallah WM, Gupta M. Prevention and Management of Infectious Complications of Retrograde Intrarenal Surgery. Front Surg 2021; 8:718583. [PMID: 34434958 PMCID: PMC8381273 DOI: 10.3389/fsurg.2021.718583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/14/2021] [Indexed: 01/11/2023] Open
Abstract
Kidney stone disease (KSD) is a commonly encountered ailment in urologic practice. Urinary tract infection (UTI) is commonly associated with KSD, both as an etiology (e.g., struvite and carbonate apatite stones), and as a complication (i.e., obstructive pyelonephritis and post-operative UTI). Indeed, a significant portion of the economic burden of KSD is skewed toward stones associated with infection. UTI is the most common post-operative complication related to stone intervention with progression to urosepsis as a rare but serious consequence. Risk for infection is influenced by a variety of factors including co-morbid conditions, anatomic abnormalities, prior surgical procedures, and local anti-microbial susceptibility. Understanding these risks and the proper steps to mitigate them is an essential component in reducing post-operative morbidity and mortality. Retrograde intrarenal surgery is routinely used for the treatment of KSD. The objective of this review article is to examine the current literature and guidelines for the prevention and management of stone-related infectious complications associated with retrograde intrarenal surgery. Special attention will be given to the incidence, etiology, and antibiotic prophylaxis choice in the management of stone-related infections. Intraoperative risk mitigation techniques will be discussed in conjunction with the management of post-operative infections. Antibiotic stewardship and the potential benefits of reduced empiric antibiotic treatment will also be discussed.
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Affiliation(s)
- Johnathan A Khusid
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - John C Hordines
- Department of Urology, SUNY Downstate College of Medicine, Brooklyn, NY, United States
| | - Areeba S Sadiq
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - William M Atallah
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Mantu Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Yoo JW, Lee KS, Chung BH, Kwon SY, Seo YJ, Lee KS, Koo KC. Optimal duration of preoperative antibiotic treatment prior to ureteroscopic lithotripsy to prevent postoperative systemic inflammatory response syndrome in patients presenting with urolithiasis-induced obstructive acute pyelonephritis. Investig Clin Urol 2021; 62:681-689. [PMID: 34387040 PMCID: PMC8566789 DOI: 10.4111/icu.20210160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/06/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE There is no consensus on the optimal duration of preoperative antibiotic treatment prior to ureteroscopic lithotripsy in patients presenting with urolithiasis-induced obstructive acute pyelonephritis (APN). We aimed to identify surgeon-modifiable, preoperative risk factors associated with postoperative systemic inflammatory response syndrome (SIRS) in these patients. MATERIALS AND METHODS This multicenter retrospective study evaluated 115 patients who presented with urolithiasis-induced obstructive APN between January 2008 and December 2019. All patients were administered intravenous third-generation cephalosporin until culture sensitivity confirmation or until ureteroscopic lithotripsy. Data were collected for age, sex, diabetes mellitus, performance status, stone features, hydronephrosis grade, preoperative renal collecting system drainage, laboratory data, operative time, and duration of preoperative antibiotic treatment. Sensitivity analysis using Youden's index and logistic regression analysis were used to assess risk factors of postoperative SIRS. RESULTS Postoperative SIRS was identified in 32 (27.8%) patients. The incidence of postoperative SIRS was higher in patients who received preoperative antibiotic treatment for fewer than 14 days (38.8% vs. 12.5%; p=0.001). Backward variable selection logistic regression analysis revealed maximal stone diameter ≥15 mm, duration of preoperative antibiotic treatment <14 days, and preoperative C-reactive protein (CRP) level ≥6.0 mg/L to be associated with higher risk of postoperative SIRS. CONCLUSIONS Patients with urolithiasis-induced obstructive APN planned for ureteroscopic lithotripsy should be administered at least 14 days of preoperative antibiotic administration and achieve a serum CRP level ≤6.0 mg/L to minimize the risk of postoperative SIRS.
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Affiliation(s)
- Jeong Woo Yoo
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kwang Suk Lee
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Ha Chung
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se Yun Kwon
- Department of Urology, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Young Jin Seo
- Department of Urology, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Kyung Seop Lee
- Department of Urology, Keimyung University Gyeongju Dongsan Hospital, Keimyung University School of Medicine, Gyeongju, Korea
| | - Kyo Chul Koo
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Peng C, Chen Z, Xu J. Risk factors for urinary infection after retrograde upper urinary lithotripsy: Implication for nursing. Medicine (Baltimore) 2021; 100:e26172. [PMID: 34397789 PMCID: PMC8341329 DOI: 10.1097/md.0000000000026172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/03/2021] [Accepted: 05/08/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT There are needs to evaluate the risk factors for urinary infection after retrograde upper urinary lithotripsy, to provide insights into the management and nursing care of patients with retrograde upper urinary lithotripsy.Patients who received retrograde upper urinary lithotripsy with a Foley 20 urinary tube insertion from June 1, 2019 to December 31, 2020 in our hospital were selected. Patients were grouped urinary infection and no infection group according to the culture results of urine, and the clinical data of the 2 groups of patients were collected and compared. Single factor and logistic regression analysis were used to analyze the risk factors of urinary tract infection after retrograde upper urinary lithotripsy.Four hundred ten patients with retrograde upper urinary lithotripsy were included, of whom 62 patients had the urinary tract infection, the incidence of urinary tract infection was 15.12%. There were significant differences in the gender, age, diabetes, stone diameter, duration of urinary tube insertion and duration of surgery between infection and no-infection group (all P < .05). The Escherichia coli (62.90%) was the most commonly seen bacterial in patients with urinary tract infection. Female (odds ratio [OR]: 1.602, 95% confidence interval 95% [CI]: 1.132∼2.472), age >50 years (OR: 2.247, 95% CI: 1.346∼3.244), diabetes (OR: 2.228, 95% CI: 1.033∼3.451), stone diameter ≥2 cm (OR: 2.152, 95% CI: 1.395∼3.099), duration of urinary tube insertion ≥3 days (OR: 1.942, 95% CI:1.158∼2.632), duration of surgery ≥90 minutes (OR: 2.128, 95% CI: 1.104∼3.846) were the independent risk factors for the postoperative urinary tract infection in patients with retrograde upper urinary lithotripsy (all P < .05).The incidence of urinary tract infection in patients undergoing retrograde upper urinary lithotripsy was high, counteractive measures targeted on those risk factors are needed to prevent and reduce the postoperative urinary infection in clinical settings.
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15
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Kim DS, Yoo KH, Jeon SH, Lee SH. Risk factors of febrile urinary tract infections following retrograde intrarenal surgery for renal stones. Medicine (Baltimore) 2021; 100:e25182. [PMID: 33787599 PMCID: PMC8021282 DOI: 10.1097/md.0000000000025182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/25/2021] [Indexed: 01/04/2023] Open
Abstract
We aimed to evaluate the risk factors of febrile urinary tract infection (UTI) following retrograde intrarenal surgery (RIRS) for treating renal stones.We retrospectively reviewed the data of patients with 10 - 30 mm kidney stones who underwent RIRS from January 2014 to July 2017. Evaluation included age, gender, body mass index, stone size, stone location, and operative time. All surgeries were performed by a single surgeon and ureteral stenting was not done prior surgery. The risk factors of febrile UTI after RIRS were assessed by univariate and multivariate logistic regression analysis.A total of 150 patients were included in the present study, and 17 patients (11.3%) had febrile UTI after RIRS. Mean patient age was 56.64 ± 13.91 years, and both genders were evenly distributed. Mean stone size was 14.16 ± 5.89 mm. and mean operation time was 74.50 ± 42.56 minutes. According to univariate analysis, preoperative pyuria was associated with postoperative febrile UTI. Multivariate logistic regression analysis showed that preoperative pyuria was the only independent risk factor of infectious complications after RIRS (odds ratios 8.311, 95% confidence intervals 1.759 - 39.275, P = .008). Age, gender, body mass index, comorbidity, preoperative bacteriuria, presence of hydronephrosis, renal stone characteristics, and operative time were not associated with febrile UTI after RIRS.Preoperative pyuria was the only risk factor of infectious complications following RIRS. Therefore, careful management after RIRS is necessary especially when preoperative urinalysis shows pyuria.
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16
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Ma YC, Jian ZY, Yuan C, Li H, Wang KJ. Risk Factors of Infectious Complications after Ureteroscopy: A Systematic Review and Meta-Analysis Based on Adjusted Effect Estimate. Surg Infect (Larchmt) 2020; 21:811-822. [PMID: 32286933 DOI: 10.1089/sur.2020.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Yu-Cheng Ma
- Department of Urology, Institute of Urology, Laboratory of Reconstructive Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R.China
| | - Zhong-Yu Jian
- Department of Urology, Institute of Urology, Laboratory of Reconstructive Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R.China
| | - Chi Yuan
- Department of Urology, Institute of Urology, Laboratory of Reconstructive Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R.China
| | - Hong Li
- Department of Urology, Institute of Urology, Laboratory of Reconstructive Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R.China
| | - Kun-Jie Wang
- Department of Urology, Institute of Urology, Laboratory of Reconstructive Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R.China
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17
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Zhang H, Jiang T, Gao R, Chen Q, Chen W, Liu C, Mao H. Risk factors of infectious complications after retrograde intrarenal surgery: a retrospective clinical analysis. J Int Med Res 2020; 48:300060520956833. [PMID: 32993406 PMCID: PMC7536499 DOI: 10.1177/0300060520956833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/14/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Stone disease is one of the most common afflictions in modern society. Complications following retrograde intrarenal surgery (RIRS) vary considerably, and small-diameter ureteral access sheaths are reportedly significantly associated with rates of infectious complications following RIRS. This study aimed to explore additional risk factors for infectious complications after RIRS. METHODS This study retrospectively analyzed 602 patients who underwent RIRS between December 2016 and October 2019 at the First Affiliated Hospital of Fujian Medical University. All flexible ureteroscopic lithotripsy processes were conducted with patients under general anesthesia in the low lithotomy position. Postoperative systemic inflammatory response syndrome (SIRS) was diagnosed; statistical analyses comprised two-way analysis of variance (ANOVA) and one-way multivariate ANOVA. RESULTS The incidence of infectious complications after RIRS was 7.14%. Operative time was an independent risk factor that increased the risk of infection. Stone size >2 cm was observed in 153 (27.37%) patients in the SIRS group and 29 patients (67.44%) in the non-SIRS group. CONCLUSIONS Findings in the literature suggest that early antibiotic treatment and active fluid therapy might lower the rate of infectious complications after RIRS. Our results indicate that extended operative time and increased stone size may be risk factors for infectious complications after RIRS.
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Affiliation(s)
- Hua Zhang
- Department of Urology, The First Affiliated Hospital
of Fujian Medical University, Fuzhou, P. R. China
| | - Tao Jiang
- Department of Urology, The First Affiliated Hospital
of Fujian Medical University, Fuzhou, P. R. China
| | - Rui Gao
- Department of Urology, The First Affiliated Hospital
of Fujian Medical University, Fuzhou, P. R. China
| | - Qin Chen
- Department of Urology, The First Affiliated Hospital
of Fujian Medical University, Fuzhou, P. R. China
| | - Weiwen Chen
- Department of Urology, The First Affiliated Hospital
of Fujian Medical University, Fuzhou, P. R. China
| | - Changyi Liu
- Department of Urology, The First Affiliated Hospital
of Fujian Medical University, Fuzhou, P. R. China
| | - Houping Mao
- Department of Urology, The First Affiliated Hospital
of Fujian Medical University, Fuzhou, P. R. China
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18
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Kim JW, Lee YJ, Ha YS, Lee JN, Kim HT, Chun SY, Kim BS. Secondary signs on preoperative CT as predictive factors for febrile urinary tract infection after ureteroscopic lithotripsy. BMC Urol 2020; 20:131. [PMID: 32854678 PMCID: PMC7457253 DOI: 10.1186/s12894-020-00701-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 08/20/2020] [Indexed: 11/29/2022] Open
Abstract
Background Febrile urinary tract infection (UTI) is one of the most common complications after ureteroscopic lithotripsy (URS). We evaluated the effect of secondary signs on preoperative computed tomography (CT) for febrile UTI after URS. Methods In total, 182 patients who underwent URS for ureteral stones from January 2013 to December 2015 were retrospectively included in this study. These patients were divided into two groups according to the presence of postoperative febrile UTI after URS. We compared the clinical factors, stone factors, and secondary signs between the groups. Predictive factors for febrile UTI after URS were analyzed using a multivariate logistic regression model. Results Febrile UTI occurred in 26 of the 182 patients. In univariate analysis, presence of comorbid chronic kidney disease (CKD) and stone size were significantly different between UTI and non-UTI groups. Among secondary signs, presence of hydroureter, perinephric fat stranding, periureteral fat stranding, and tissue rim sign were significantly different between the groups. In multivariate logistic regression analysis, comorbid CKD, stone size, perinephric fat stranding, and tissue rim sign were independent predictive factors for febrile UTI after URS. Conclusion This study demonstrated that secondary signs including perinephric fat stranding and tissue rim sign on preoperative CT, CKD, and stone size are independent predictive factors for febrile UTI after URS.
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Affiliation(s)
- Jin Woo Kim
- Department of Urology, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea
| | - You Jin Lee
- Department of Urology, Pohang Semyeng Christianity Hospital, Pohang, South Korea
| | - Yun-Sok Ha
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, South Korea.,Department of Urology, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Jun Nyung Lee
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, South Korea.,Department of Urology, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Hyun Tae Kim
- Department of Urology, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - So Young Chun
- BioMedical Research Institute, Joint Institute for Regenerative Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Bum Soo Kim
- Department of Urology, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea. .,Department of Urology, School of Medicine, Kyungpook National University, Daegu, South Korea.
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19
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Meng X, Cong R, Song R, Lu P, Zhang W, Wang Z. Multiple renal ruptures after flexible ureteroscopic lithotripsy with holmium laser. AME Case Rep 2020; 4:1. [PMID: 32206747 DOI: 10.21037/acr.2019.12.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/20/2019] [Indexed: 11/06/2022]
Abstract
The authors present a case report of multiple renal ruptures after flexible ureteroscopic lithotripsy (FURL) with holmium laser. Multiple renal ruptures following flexible ureterorenoscopy have not been reported so far. The etiology remains unclear. We like to share this case to make urologists aware of this unusual complication and discuss possible causes and therapeutic approaches.
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Affiliation(s)
- Xianghu Meng
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Rong Cong
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Rijin Song
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Pei Lu
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Wei Zhang
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zengjun Wang
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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Sun J, Xu J, OuYang J. Risk Factors of Infectious Complications following Ureteroscopy: A Systematic Review and Meta-Analysis. Urol Int 2019; 104:113-124. [DOI: 10.1159/000504326] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 10/20/2019] [Indexed: 11/19/2022]
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