Can We Identify Patients in Danger of Complications in Retrograde Intrarenal Surgery?—A Retrospective Risk Factors Analysis

Abstract

Retrograde intrarenal surgery (RIRS) is an innovative and effective method of kidney stones treatment, as it had great influence on the development of endoscopy in urology. The increasing prevalence of urolithiasis together with the rapid development of endourology leads to a rise in the number of procedures related to the disease. Flexible ureteroscopy is constantly being improved, especially regarding the effectiveness and safety of the procedure. The purpose of this study is to evaluate intraoperative and early post-operative complications of RIRS in the treatment of kidney stones. A retrospective analysis of medical records was performed. A series was comprised of 207 consecutive operations performed from 2017 to 2020. Complications occurred in 19.3% (n = 40) of patients. Occurrence according to the Clavien-Dindo scale was: 11.1% for grade I, 5.8% for grade II and 2.4% for grade IV. Infectious complications included SIRS (5.3%, n = 11) and sepsis (2.4%, n = 5). Statistical analysis revealed a correlation between acute post-operative infections and positive midstream urine culture, history of chronic or recurrent urinary tract infections, and increased body mass index (BMI). Furthermore, a significant correlation was observed between pain requiring the use of opioids with BMI over 25. Consequently, history of urinary tract infections, positive pre-operative urine culture, and increased BMI are considered risk factors and require appropriate management.

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

“…Martov et al [39] confirmed that female gender was a specific risk factor for infectious complications after RIRS. In contrast, other reports state that female gender is irrelevant in the occurrence of SIRS or sepsis [11] , [40] . In our study, female gender was constantly found as a risk factor for sepsis [19] , [21] , [23] , [29] .…”

“…Sepsis caused by infection of the urogenital tract, also known as urosepsis, is the most serious complication of RIRS [11] , [12] . It is therefore important to identify, before the surgery, the specific risk factors for postoperative sepsis.…”

Can We Identify Patients in Danger of Delayed Treatment? Management of COVID-19 Pandemic Backlog in Urology Care in Poland

“…Over the presented period, the use of laser in ureteroscopy was so prevalent that it had superseded the harness of pneumatic lithoclast and laparoscopic ureterolithotomy. Another treatment method that was also on the rise and became widely available was the flexible ureteroscopy, which replaced the multiple SWL sessions and enabled an effective treatment [ 20 ]. While the RIRS is usually an elective operation, the rates remained similar in 2019 and 2020.…”