Prevention and management of urosepsis triggered by ureteroscopy

Scotland, Kymora B.; Lange, Dirk

doi:10.2147/rru.s128071

Cited by 31 publications

(40 citation statements)

References 54 publications

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“…[ 21 ] However, due to the lack of supporting systematic reviews and evidence, only a consensus on good clinical practices such as limiting the operative time, maintaining a low irrigation pressure, and consistent decompression of the upper urinary tract is available. [ 22 ] The factors related to surgical procedures were constant among the subjects in our study; this allowed us to rule out intra-operative components as risk factors of postoperative UTI, and we were able to focus more on patient-related and renal stone-related factors in this study.…”

Section: Discussionmentioning

confidence: 99%

Risk factors of febrile urinary tract infections following retrograde intrarenal surgery for renal stones

Kim

Yoo²,

Jeon³

et al. 2021

Medicine

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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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Section: Discussionmentioning

confidence: 99%

Risk factors of febrile urinary tract infections following retrograde intrarenal surgery for renal stones

Kim

Yoo²,

Jeon³

et al. 2021

Medicine

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“…Urosepsis is a dysregulated systemic inflammatory response to a urogenital infection. Generally, it occurs secondary to the dissemination of a previously localized uropathogenic bacterial infection into the blood stream [ 4 ]. Patients that experience urosepsis have a mortality rate of 20%–40%, which increases to 50% in patients who experience refractory septic shock [ 4 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Generally, it occurs secondary to the dissemination of a previously localized uropathogenic bacterial infection into the blood stream [ 4 ]. Patients that experience urosepsis have a mortality rate of 20%–40%, which increases to 50% in patients who experience refractory septic shock [ 4 5 ]. Given the high mortality rates, investigation into predictive factors for urosepsis in struvite stone patients receiving treatment is warranted.…”

Section: Introductionmentioning

confidence: 99%

Predictors of urosepsis in struvite stone patients after percutaneous nephrolithotomy

Chan

Wong

et al. 2021

Investig Clin Urol

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Purpose This study aims to identify clinical factors that may predispose struvite stone patients to urosepsis following percutaneous nephrolithotomy (PCNL). Materials and Methods A retrospective review was conducted on patients who received PCNL for struvite stones. The Systemic Inflammatory Response Syndrome (SIRS) criteria and quick-Sepsis Related Organ Failure Assessment (q-SOFA) criteria were used to identify patients who were at an increased risk for urosepsis. Statistical analysis was performed using Fisher's exactness test, Wilcoxon rank test, and logistic regression. Results Chart review identified 99 struvite stone patients treated with PCNL. Post-operatively, 40 patients were SIRS positive (≥2 criteria) and/or q-SOFA positive (score ≥2). Using SIRS as an approximation for urosepsis, longer operative times (p<0.001), higher pre-operative white blood cell counts (p=0.01), greater total stone surface area (p<0.0001), and pre-operative stenting (OR, 5.75; p=0.01) were identified as independent risk factors for urosepsis. Multivariate analysis demonstrated pre-operative stenting (OR, 1.46; p=0.01) to be a risk factor. With q-SOFA, univariable analysis found that antibiotic use within 3 months prior to a PCNL (OR, 4.44; p=0.04), medical comorbidities (OR, 4.80; p=0.02), longer operative times (p<0.001), lengthier post-operative hospitalization (p<0.01), and greater total stone surface area (p<0.0001) were risk factors for urosepsis. Multivariate analysis revealed that bladder outlet obstruction (OR, 2.74; p<0.003) and pre-operative stenting (OR, 1.27; p=0.01) significantly increased odds of being q-SOFA positive. Conclusions Several risk factors for urosepsis following PCNL for struvite stones have been identified. These risk factors should be taken into consideration in peri-operative care to mitigate the risks of urosepsis.

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“…Bacterial infections may cause RBD (Deng et al, 2017[ 4 ]). Urosepsis caused by ureteroscopy is considered a potentially life-threatening infection (Scotland and Lange, 2018[ 14 ]). RBD may be caused by several different reasons (Table 1 (Tab.…”

Section: Discussionmentioning

confidence: 99%

Severe rhabdomyolysis in homozygote carnitine palmitoyltransferase II deficiency

Schnedl¹,

Enko

Mangge

2020

EXCLI Journal; 19:Doc1309; ISSN 1611-2156

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Prevention and management of urosepsis triggered by ureteroscopy

Cited by 31 publications

References 54 publications

Risk factors of febrile urinary tract infections following retrograde intrarenal surgery for renal stones

Risk factors of febrile urinary tract infections following retrograde intrarenal surgery for renal stones

Predictors of urosepsis in struvite stone patients after percutaneous nephrolithotomy

Severe rhabdomyolysis in homozygote carnitine palmitoyltransferase II deficiency

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