Risk factors for Infectious Complications of Ureteroscopy after Obstructive Acute Pyelonephritis
Urology Journal,
Vol. 20 No. 02 (2023),
27 February 2023
,
Page 90-95
https://doi.org/10.22037/uj.v20i02.7241
Abstract
Objectives: To identify risk factors for infectious complication of ureteroscopy after obstructive acute pyelonephritis (OAPN).
Patients and Methods: This single-center, retrospective cohort study (#20200002, retrospectively registered in February 1st, 2020) included patients who underwent emergency drainage for OAPN and subsequently underwent ureteroscopic stone removal between January 2006 and December 2020. Multivariable analysis was conducted using demographic and stone-related factors to determine those that could predict postoperative febrile urinary tract infection (UTI).
Results: Overall, 432 patients underwent ureteroscopy after OAPN. The stone-free rate was 84.3%, whereas the overall and major complication rates were 17.6% and 3.2%, respectively. A total of 70 (16.2%) patient developed febrile UTI, among whom 34 (7.9%) and 11 (2.5%) developed sepsis and severe sepsis, respectively. Multivariable analysis identified diabetes mellitus [odds ratio (OR) 1.98, 95% confidence interval (CI) 1.05–3.74], duration from drainage to surgery >1 month (OR 2.28, 95% CI 1.20–4.74), and simultaneous retrograde intrarenal surgery (OR 2.96, 95% CI 1.35–6.48) as significant risk factors for UTI. After dividing patients into low- (0), intermediate- (1), and high- (2–3) risk groups according to the number of factors they had, the risk of postoperative UTI was 6.3%, 14.5%, and 27.7%, respectively (p for trend <0.001).
Conclusions: Patients who underwent ureteroscopy after OAPN were at risk for postoperative UTI, despite its efficacy. Simultaneous retrograde intrarenal surgery should be carefully planned, especially for patients with diabetes mellitus or extended surgery wait times.
- lithotripsy laser
- postoperative complication
- pyelonephritis
- sepsis
- ureteroscopy
- urolithiasis
How to Cite
References
Yoshimura K, Utsunomiya N, Ichioka K, Ueda N, Matsui Y, Terai A. Emergency drainage for urosepsis associated with upper urinary tract calculi. J Urol. 2005; 173: 458-62.
Hamasuna R, Takahashi S, Nagae H et al. Obstructive pyelonephritis as a result of urolithiasis in Japan: diagnosis, treatment and prognosis. Int J Urol. 2015; 22: 294-300.
Sammon JD, Ghani KR, Karakiewicz PI et al. Temporal trends, practice patterns, and treatment outcomes for infected upper urinary tract stones in the United States. Eur Urol. 2013; 64: 85-92.
Uchida Y, Takazawa R, Kitayama S, Tsujii T. Predictive risk factors for systemic inflammatory response syndrome following ureteroscopic laser lithotripsy. Urolithiasis. 2018; 46: 375-81.
Nevo A, Mano R, Baniel J, Lifshitz DA. Ureteric stent dwelling time: a risk factor for post-ureteroscopy sepsis. BJU Int. 2017; 120: 117-22.
Youssef RF, Neisius A, Goldsmith ZG et al. Clinical outcomes after ureteroscopic lithotripsy in patients who initially presented with urosepsis: matched pair comparison with elective ureteroscopy. J Endourol. 2014; 28: 1439-43.
Pietropaolo A, Hendry J, Kyriakides R et al. Outcomes of Elective Ureteroscopy for Ureteric Stones in Patients with Prior Urosepsis and Emergency Drainage: Prospective Study over 5 yr from a Tertiary Endourology Centre. Eur Urol Focus. 2020; 6: 151-6.
Yamashita S, Kohjimoto Y, Higuchi M, Ueda Y, Iguchi T, Hara I. Postoperative Progress after Stone Removal Following Treatment for Obstructive Acute Pyelonephritis Associated with Urinary Tract Calculi: A Retrospective Study. Urol J. 2020; 17: 118-23.
Kanno T, Matsuda A, Sakamoto H, Higashi Y, Yamada H. Safety and efficacy of ureteroscopy after obstructive pyelonephritis treatment. Int J Urol. 2013; 20: 917-22.
Yoo JW, Lee KS, Chung BH, Kwon SY, Seo YJ, 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: 681-9.
Itami Y, Miyake M, Owari T et al. Optimal timing of ureteroscopic lithotripsy after the initial drainage treatment and risk factors for postoperative febrile urinary tract infection in patients with obstructive pyelonephritis: a retrospective study. BMC Urol. 2021; 21: 10.
Berardinelli F, De Francesco P, Marchioni M et al. Infective complications after retrograde intrarenal surgery: a new standardized classification system. Int Urol Nephrol. 2016; 48: 1757-62.
Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant. 2013; 48: 452-8.
Sun J, Xu J, OuYang J. Risk Factors of Infectious Complications following Ureteroscopy: A Systematic Review and Meta-Analysis. Urol Int. © 2019 S. Karger AG, Basel., Switzerland 2020; 113-24.
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: 811-22.
Troxel SA, Low RK. Renal intrapelvic pressure during percutaneous nephrolithotomy and its correlation with the development of postoperative fever. J Urol. 2002; 168: 1348-51.
Tokas T, Skolarikos A, Herrmann TRW, Nagele U. Pressure matters 2: intrarenal pressure ranges during upper-tract endourological procedures. World J Urol. 2019; 37: 133-42.
Hanna B, Zhuo K, Chalasani V et al. Association between ureteric stent dwell time and urinary tract infection. ANZ J Surg. 2020.
Kawahara T, Ito H, Terao H, Yoshida M, Matsuzaki J. Ureteral stent encrustation, incrustation, and coloring: morbidity related to indwelling times. J Endourol. 2012; 26: 178-82.
Nevo A, Golomb D, Lifshitz D, Yahav D. Predicting the risk of sepsis and causative organisms following urinary stones removal using urinary versus stone and stent cultures. Eur J Clin Microbiol Infect Dis. 2019; 38: 1313-8.
Al-Ghazo MA, Ghalayini IF, Matani YS, El-Radaideh KM, Haddad HI. The risk of bacteriuria and ureteric stent colonization in immune-compromised patients with double J stent insertion. Int Urol Nephrol. 2010; 42: 343-7.
Chugh S, Pietropaolo A, Montanari E, Sarica K, Somani BK. Predictors of Urinary Infections and Urosepsis After Ureteroscopy for Stone Disease: a Systematic Review from EAU Section of Urolithiasis (EULIS). Curr Urol Rep. 2020; 21: 16.
Paranjpe I, Kapoor A, Tran T et al. Multi-institutional Predictors of Antibiotic Resistance in Patients Presenting to the Emergency Department with Urosepsis Secondary to Ureteral Obstruction. J Endourol. 2020.
Senocak C, Ozcan C, Sahin T et al. Risk Factors of Infectious Complications after Flexible Uretero-renoscopy with Laser Lithotripsy. Urol J. 2018; 15: 158-63.
- Abstract Viewed: 425 times
- 7241/pdf Downloaded: 289 times