Risk Factors for Urological Complications Associated with Caesarean Section—A Case-Control Study

Radu, Viorel Dragos; Pristavu, Anda; Vinturache, Angela; Onofrei, Pavel; Socolov, Demetra; Cărăuleanu, Alexandru; Boiculese, Lucian; Scripcariu, Sadyie Ioana; Costache, R.C.

doi:10.3390/medicina58010123

Cited by 13 publications

(4 citation statements)

References 19 publications

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“…In patients discharged without indwelling urinary catheters, the infection rate was low, although patients were exposed to the same risk of infection in hospital as patients with urinary catheters. In other local studies, we have not reported the occurrence of MDR UTIs in patients discharged without urinary catheters [45]. It is likely that a normal urinary system without a urinary catheter does not develop UTIs despite possible contamination with CR Kpn, which is why we do not suggest screening all discharged patients for MDR UTIs as in other studies [46], but only those patients discharged with urinary catheters, especially if their removal is not expected for a long time.…”

Section: Discussionmentioning

confidence: 68%

Urinary Tract Infections with Carbapenem-Resistant Klebsiella pneumoniae in a Urology Clinic—A Case-Control Study

Radu,

Costache,

Onofrei

et al. 2024

Antibiotics

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Background: The aim of our study was to analyze the factors associated with the increased risk of urinary tract infection (UTI) with carbapenem-resistant (CR) Klebsiella pneumoniae (Kpn) and the antibiotic resistance spectrum of the strains in patients. As secondary objectives, we elaborated the profile of these patients and the incidence of different types of carbapenemases. Methods: We conducted a retrospective case-control study in which we compared a group of 62 patients with urinary tract infections with CR Kpn with a control group consisting of 136 patients with urinary tract infections with multidrug-resistant (MDR), but carbapenem-sensitive (CS), Kpn, who were hospitalized between 1 January 2022 and 31 March 2024. Results: Compared to patients with urinary tract infections with CS Kpn, patients with urinary tract infections with CR Kpn were preponderant in rural areas (62.9% vs. 47.1%, p = 0.038) and more frequently had an upper urinary tract infection (69.4% vs. 36.8%, p < 0.01). Among the risk factors examined, patients in the study group had a higher presence of urinary catheters inserted for up to one month (50% vs. 34.6%, p = 0.03), rate of hospitalization in the last 180 days (96.8% vs. 69.9%, p < 0.01) and incidence of antibiotic therapy in the last 180 days (100% vs. 64.7%, p < 0.01). They also had a higher rate of carbapenem treatment in the last 180 days (8.1% vs. 0%, p < 0.01). Patients in the study group had a broader spectrum of resistance to all antibiotics tested (p < 0.01), with the exception of sulfamethoxazole–trimethoprim, where the resistance rate was similar in both groups (80.6% vs. 67.6%, p = 0.059). In the multivariate analysis, transfer from other hospitals (OR = 3.51, 95% and CI: 1.430–8.629) and treatment with carbapenems in the last 180 days (OR = 11.779 and 95% CI: 1.274–108.952) were factors associated with an increased risk of disease compared to the control group. The presence of carbapenemases was observed in all patients with CR Kpn, in the order of frequency New Delhi metallo-ß-lactamase (NDM) (52.2%), Klebsiella pneumoniae carbapenemase (KPC) (32.6%), and carbapenem-hydrolyzing oxacillinase (Oxa-48) (15.2%). Conclusions: The environment of origin and previous treatment with carbapenems appear to be the factors associated with an increased risk of urinary tract infection with CR Kpn compared to patients with urinary tract infections with CS Kpn. CR Kpn exhibits a broad spectrum of antibiotic resistance, among which is resistance to carbapenem antibiotics.

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Section: Discussionmentioning

confidence: 68%

Urinary Tract Infections with Carbapenem-Resistant Klebsiella pneumoniae in a Urology Clinic—A Case-Control Study

Radu,

Costache,

Onofrei

et al. 2024

Antibiotics

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“…The administration of multiple ESWL sessions prolongs the time to achieve stone-free status and thus increases the risk of reflux, pyelonephritis, and double-J syndrome, as emphasized in other studies [ 13 , 27 - 29 ]. Reflux pyelonephritis can be a serious complication that can quickly lead to urosepsis in the absence of adequate antibiotic treatment [ 30 ]. However, as in other studies [ 28 , 31 ], the incidence of symptoms associated with double-J catheters in our study was much lower than the nearly 80% reported in other studies [ 13 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Extracorporeal Shock Wave Lithotripsy (ESWL) in Patients With Infected Ureterohydronephrosis Due to Ureteral Stones Following Double-J Catheter Insertion

Bandac,

Ristescu,

Costache

et al. 2024

Cureus

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Introduction: Double-J ureteral catheters in patients with ureteral lithiasis undergoing extracorporeal shockwave lithotripsy (ESWL) procedures reduce the efficacy of the procedure or have no effect on the stone-free rate. However, the effect of double-J catheters on the patients in whom they were inserted for infected hydronephrosis is not known. The aim of our study was to evaluate the efficacy and safety of the ESWL procedure in patients with ureteral lithiasis and double-J catheters previously inserted for infected hydronephrosis. Method: We conducted a comparative case-control, match-paired study in a group of patients with ureteral lithiasis treated by ESWL from January 1, 2018, to March 1, 2023, who were divided into two groups according to the presence of the double-J catheter. For each patient with the double-J catheter from the study group, we selected one patient for the control group without the double-J catheter and matched them in terms of size, location of stones, and body mass index (BMI). We analyzed the stone-free rate and complications that occurred in the two groups. Results: Forty patients with ureteral lithiasis and a double-J catheter inserted for infected hydronephrosis were enrolled in the study group. The control group included 40 patients with ureteral stones without double-J catheters. The patients in the two groups were predominantly men with stones located in the lumbar region and on the right side and with a BMI between 25 and 30 kg/m 2 . The stones had an average size of 0.9+/-0.12mm and 0.89+/-0.15mm, respectively (p=0.624). There was no statistically significant difference in stone-free rate between the two groups after the first session of ESWL (47.5% vs. 52.5%, p=0.502), the second (70% vs. 75%, p = 0.616), and the third session (85% vs. 87.5%, p=0.761). The rate of complications was similar in both groups (7.5% vs. 5%, p=0.761). Conclusions: The presence of double-J catheters inserted in patients with ureteral stones who underwent ESWL for infected hydronephrosis does not affect the stone-free rate of the procedure or the complication rate. The procedure of ESWL in patients with ureteral lithiasis and double-J catheters inserted for infected hydronephrosis is a safe and efficient method that can be recommended as an initial treatment alongside retrograde ureteroscopy.

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“…Bladder injuries are usually recognized and addressed intraoperatively, but this may not always be possible (4), and there exists the possibility of diagnosis and intervention in the early period after the CS.…”

Section: Introductionmentioning

confidence: 99%

Management of Bladder Injury During Caesarean Delivery and Long-Term Results

Tunçekin,

Yalçın

2024

Preprint

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Purpose: The urinary bladder injury after cesarean delivery is rare but significant. This study aims to evaluate the management of bladder injuries after cesarean section and long-term postoperative results. Methods: Our study included 67 patients who had bladder injuries after cesarean section and underwent repair. Patients with non-bladder genitourinary organ injuries and/or injuries other than those associated with cesarean delivery were excluded. The patients’ demographic records and pre- and postoperative data were evaluated retrospectively. Results: Between September 2018 and February 2023, 123,296 pregnant women were admitted to our hospital for birth; 46,786 (38%) cesarean deliveries occurred, and 67 patients suffered bladder injuries (0.14%). Diagnosis was made intraoperatively in 58 patients and postoperatively in 9 patients. The average age of the patients was 33,8 years and the average number of cesarean sections the patients had undergone was 3,2. The average bladder defect size was 4,4 cm, and they were most frequently observed in the bladder dome. When evaluated in the early period (first month postpartum) and late period (after the first month), lower urinary tract symptoms were observed in a total of 16 patients, and the most common symptom was dysuria. Conclusions: Bladder injury during cesarean delivery is a rare but serious condition. When bladder injury is suspected, diagnosis and treatment should be done promptly to minimize complications. Our study draws attention to this topic, and prospective studies with larger populations and longer follow-up periods are needed to obtain more conclusive results.

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Risk Factors for Urological Complications Associated with Caesarean Section—A Case-Control Study

Cited by 13 publications

References 19 publications

Urinary Tract Infections with Carbapenem-Resistant Klebsiella pneumoniae in a Urology Clinic—A Case-Control Study

Urinary Tract Infections with Carbapenem-Resistant Klebsiella pneumoniae in a Urology Clinic—A Case-Control Study

Efficacy and Safety of Extracorporeal Shock Wave Lithotripsy (ESWL) in Patients With Infected Ureterohydronephrosis Due to Ureteral Stones Following Double-J Catheter Insertion

Management of Bladder Injury During Caesarean Delivery and Long-Term Results

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