Urosepsis after ureterorenoscopy, intraoperative recognition of type-IV stones could change clinical practice

• Published in: World journal of urology 2024-09, Vol.42 (1), p.534, Article 534
• Main Authors: Pattou, Maxime, Yonneau, Laurent, de Gouvello, Amaury, Almeras, Christophe, Saussine, Christian, Hoznek, Andras, Denis, Etienne, Chabannes, Eric, Lechevallier, Eric, Abid, Nadia, Hubert, Jacques, Estrade, Vincent, Meria, Paul
• Format: Article
• Language: English
• Subjects: Aged; Calculi; Cardiovascular disease; Clinical medicine; Diabetes; Endoscopes; Female; Hospital costs; Humans; Implants; Kidney Calculi - surgery; Kidney diseases; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate analysis; Nephrology; Oncology; Patients; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Prospective Studies; Regression analysis; Risk Factors; Sepsis; Sepsis - epidemiology; Sepsis - etiology; Struvite; Surgeons; Ureter; Ureteral Calculi - surgery; Ureteroscopy - adverse effects; Urinary Tract Infections - epidemiology; Urinary Tract Infections - etiology; Urine; Urology
• ISSN: 1433-8726; 0724-4983; 1433-8726
• DOI: 10.1007/s00345-024-05251-3

Objectives Urosepsis currently accounts for half of all post flexible ureterorenoscopy (F-URS) complications, with an incidence of up to 4.3%. It represents a quarter of all septic episodes in adults and 2% of hospital spendings. The primary objective of this study was to define the predictive clinical parameters that increase the risk of urosepsis after F-URS. Subjects/patients (or materials) and methods This prospective multicentric study evaluated patients who underwent F-URS for calculus between June 2016 and June 2018 in eleven French centers. Clinical, bacteriological, morpho-constitutional stone data, intraoperative information and complications were compared. Risk factors for postoperative urosepsis were identified and analyzed. Results We included 486 F-URS in 432 patients. The ureter was prepared using a double J stent in 51% of cases, a digital endoscope was used in 56% of patients with a median operative time of 120 min IQR (90–125) and using a sheath in 90% of cases. Postoperative urosepsis was observed in 18 patients (4%) with a median time to onset of 2 days IQR (1–5). The presence of coronary insufficiency: 3 (17%) vs 14 (3%) p = 0.005, a larger stone diameter: 11 cm [9–17] vs 10 cm [8–13] p = 0.02, a positive preoperative urine culture even when treated: 3 (17%) vs 56 (12%) p = 0.04, as well as the final composition of the type IV calculus (carbapatite or struvite) 5 (28%) vs 20 (4%) p