Application of Suctioning Ureteral Access Sheath during Flexible Ureteroscopy for Renal Stones Decreases the Risk of Postoperative Systemic Inflammatory Response Syndrome.

Jiaqiao Zhang,Senyuan Hong,Jianning Zhu,Shaogang Wang,Xiaoyuan Qian,Can Qian,Chenqian Liu,Jinzhou Xu,Tun-Chieh Chen

doi:10.1155/2022/9354714

Abstract

Purpose To clarify the efficiency and outcomes of suctioning ureteral access sheath (UAS) during flexible ureteroscopic lithotripsy (fURL) for the management of renal stones. Methods Between January 2017 and January 2019, a total of 444 patients with renal stones undergoing fURL were divided into suctioning UAS and nonsuctioning UAS groups. The outcomes of patients in both groups were compared using a matched-pair analysis (1 : 1 scenario). Furthermore, a directed acyclic graph (DAG) was drawn to guide the multivariate logistic regression model and analyze the protective effect of suctioning UAS on the incidence of postoperative systemic inflammatory response syndrome (SIRS). Results Before propensity score matching, significant differences were observed between the two groups in blood white cell counts, urine white cell counts, preoperative fever, preoperative indwelling stents, and laterality (P < 0.05). Eighty-one patients in the suctioning UAS group were successfully matched with 81 patients in the nonsuctioning group. The stone-free rate (SFR) on postoperative day 1 after fURL in the suctioning group was higher than that in the nonsuctioning group (86.4% vs. 71.6%; P=0.034), whereas it was comparable between the two groups 1 month after the surgery (88.9% vs. 82.7%; P=0.368). The incidence of postoperative fever or SIRS was lower in the suctioning group (fever: 3.70% vs. 14.8%; P=0.030; SIRS: 1.23% vs. 12.3%; P=0.012). However, the operative duration was similar in both groups (mean (SD)) (72.9 (28.1) min vs. 80.0 (29.5) min; P=0.121). The result of the multivariate logistic regression model guided by DAG revealed that the application of nonsuctioning UAS (odds ratio: 5.28 [1.38–35.07], P=0.034) during fURL was associated with postoperative SIRS. Conclusions The application of suctioning UAS during fURL was associated with higher SFR on day 1 after surgery and a lower incidence of postoperative fever or SIRS.

Highlights

Kidney stones are one of the common diseases of the urinary system and have a high incidence and recurrence rate [1, 2]
Suctioning ureteral access sheath (UAS) was used in 81 patients, while the remaining 363 patients underwent Flexible ureteroscopic lithotripsy (fURL) without suctioning UAS. e stone-free rate (SFR) was 77.7% on day one after fURL and 82.2% at one month postoperatively
A statistically significant difference (P < 0.05) was observed between the two groups in blood and urine white cell counts, preoperative fever, preoperative indwelling stents, and laterality before propensity score matching. e other preoperative factors remained balanced (P > 0.05) between the two groups. us, 81 patients in the suctioning UAS group were successfully matched with 81 patients in the nonsuctioning group (Table 1)

Summary

Introduction

Kidney stones are one of the common diseases of the urinary system and have a high incidence and recurrence rate [1, 2]. If patients are not treated in time, the collection system is blocked, which can result in serious complications [2]. Flexible ureteroscopic lithotripsy (fURL) has attracted more and more attention in the treatment of kidney stones given its advantage of being performed through a natural orifice of the human body and the low risk of direct damage to the kidney. FURL cannot actively discharge the crushed fragments. Patients take a long time to passively discharge the stones. Though some stones are crushed, they remain in the patient’s body for a period of time, which predisposes them to urinary tract infections and stone recurrence

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