Unplanned 30-Day Encounters After Ureterorenoscopy for Urolithiasis

Du, Kefu; Wang, Robert S.; Vetter, Joel; Paradis, Alethea; Figenshau, R. Sherburne; Venkatesh, Ramakrishna; Desai, Alana

doi:10.1089/end.2018.0177

Cited by 20 publications

(7 citation statements)

References 30 publications

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“…According to Traxer et al [14], UAS usage has a positive influence on SIRS reduction. There are, however, reports where UAS was associated either with postoperative complications [15] or with unplanned postoperative emergency readmissions [16]. Prospective randomized trials are urgently needed to identify clear indications for UAS, hereby also considering its drawbacks.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for a Complicated Postoperative Course in Flexible Ureteroscopy

et al. 2021

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Introduction: The goal was to determine risk factors for Clavien-Dindo (CD) grade ≥2 complications, with special focus on early postoperative systemic inflammatory response syndrome (SIRS), for flexible ureteroscopy (fURS). Materials and Methods: A retrospective monocentric statistical analysis relating to 32 factors was performed with the χ2 test, Mann-Whitney U tests, and multivariate logistic regression. Results: In total, 416 consecutive fURS performed between September 2013 and June 2017 were analyzed; 283 (68.03%) of these were for stone surgery and 133 (31.97%) for diagnostic purposes. In 43 cases (10.34%), CD ≥2 occurred; 31 cases (72.09%) of these were SIRS. On multivariate logistic regression, positive preoperative urine culture and steep pyelographic and CT-based infundibulopelvic angle (IPA) have been confirmed as independent risk factors for both CD ≥2 and SIRS. Greater maximal median stone diameter and female gender were significantly associated only with a higher CD ≥2 prevalence, but not with SIRS. The influence of ureteral access sheath (UAS) on CD ≥ 2 or SIRS occurrence could not be confirmed on multivariate analysis. Perioperative antibiotic prophylaxis for patients with negative urine culture showed no difference regarding SIRS prevalence. Conclusion: Steep CT-based IPA can be considered as a new radiologic predictor of complicated postoperative course and SIRS. The role of UAS as well as indications for perioperative antibiotic prophylaxis should be determined in prospective studies.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for a Complicated Postoperative Course in Flexible Ureteroscopy

et al. 2021

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“…Prior studies investigating infection-related complications after URS have provided some insights on risk factors, which include stone, patient, and operative characteristics. However, most are single institution series from tertiary referral or academic medical centers [ 4 – 10 ], which may limit generalizability of the results to the wider swathe of urologic patients commonly treated by diverse practitioners in community or multi-specialty group practices.…”

Section: Introductionmentioning

confidence: 99%

Infection-related hospitalization following ureteroscopic stone treatment: results from a surgical collaborative

et al. 2020

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Background Unplanned hospitalization following ureteroscopy (URS) for urinary stone disease is associated with patient morbidity and increased healthcare costs. To this effect, AUA guidelines recommend at least a urinalysis in patients prior to URS. We examined risk factors for infection-related hospitalization following URS for urinary stones in a surgical collaborative. Methods Reducing Operative Complications from Kidney Stones (ROCKS) is a quality improvement (QI) initiative from the Michigan Urological Surgery Improvement Collaborative (MUSIC) consisting of academic and community practices in the State of Michigan. Trained abstractors prospectively record standardized data elements from the health record in a web-based registry including patient characteristics, surgical details and complications. Using the ROCKS registry, we identified all patients undergoing primary URS for urinary stones between June 2016 and October 2017, and determined the proportion hospitalized within 30 days with an infection-related complication. These patients underwent chart review to obtain clinical data related to the hospitalization. Multivariable logistic regression analysis was performed to determine risk factors for hospitalization. Results 1817 URS procedures from 11 practices were analyzed. 43 (2.4%) patients were hospitalized with an infection-related complication, and the mortality rate was 0.2%. Median time to admission and length of stay was 4 and 3 days, respectively. Nine (20.9%) patients did not have a pre-procedure urinalysis or urine culture, which was not different in the non-hospitalized cohort (20.5%). In hospitalized patients, pathogens included gram-negative (61.5%), gram-positive (19.2%), yeast (15.4%), and mixed (3.8%) organisms. Significant factors associated with infection-related hospitalization included higher Charlson comorbidity index, history of recurrent UTI, stone size, intra-operative complication, and procedures where fragments were left in-situ. Conclusions One in 40 patients are hospitalized with an infection-related complication following URS. Awareness of risk factors may allow for individualized counselling and management to reduce these events. Approximately 20% of patients did not have a pre-operative urine analysis or culture, and these findings demonstrate the need for further study to improve urine testing and compliance

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“…UAS use was of significant interest since there is evidence that it decreases intrarenal pressure 17 and therefore may reduce postoperative pain. 18 On the other hand, UAS use may result in direct ureteral irritation, inflammation, injury, and potentially ischemia, 19,20 and previous studies have associated UAS use with unplanned postoperative encounters, 21,22 increased short-term pain, 13 and receipt of opioids. 14 In STENTS, we did not find that UAS use was associated with increased or decreased stent-associated symptoms, controlling for other variables.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Increased Stent-associated Symptoms Following Ureteroscopy for Urinary Stones: Results From STENTS

et al. 2023

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Purpose:The STudy to Enhance uNderstanding of sTent-associated Symptoms sought to identify risk factors for pain and urinary symptoms, as well as how these symptoms interfere with daily activities after ureteroscopy for stone treatment.Materials and Methods:This prospective observational cohort study enrolled patients aged ≥12 years undergoing ureteroscopy with ureteral stent for stone treatment at 4 clinical centers. Participants reported symptoms at baseline; on postoperative days 1, 3, 5; at stent removal; and day 30 post–stent removal. Outcomes of pain intensity, pain interference, urinary symptoms, and bother were captured with multiple instruments. Multivariable analyses using mixed-effects linear regression models were identified characteristics associated with increased stent-associated symptoms.Results:A total of 424 participants were enrolled. Mean age was 49 years (SD 17); 47% were female. Participants experienced a marked increase in stent-associated symptoms on postoperative day 1. While pain intensity decreased ∼50% from postoperative day 1 to postoperative day 5, interference due to pain remained persistently elevated. In multivariable analysis, older age was associated with lower pain intensity (P = .004). Having chronic pain conditions (P < .001), prior severe stent pain (P = .021), and depressive symptoms at baseline (P < .001) were each associated with higher pain intensity. Neither sex, stone location, ureteral access sheath use, nor stent characteristics were drivers of stent-associated symptoms.Conclusions:In this multicenter cohort, interference persisted even as pain intensity decreased. Patient factors (eg, age, depression) rather than surgical factors were associated with symptom intensity. These findings provide a foundation for patient-centered care and highlight potential targets for efforts to mitigate the burden of stent-associated symptoms.

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Unplanned 30-Day Encounters After Ureterorenoscopy for Urolithiasis

Cited by 20 publications

References 30 publications

Risk Factors for a Complicated Postoperative Course in Flexible Ureteroscopy

Risk Factors for a Complicated Postoperative Course in Flexible Ureteroscopy

Infection-related hospitalization following ureteroscopic stone treatment: results from a surgical collaborative

Risk Factors for Increased Stent-associated Symptoms Following Ureteroscopy for Urinary Stones: Results From STENTS

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