Abstract
BackgroundFlexible ureteroscopic holmium laser lithotripsy is used to treat urinary tract calculi, but postoperative complications include shivering, fever and infection. To investigate the effects of irrigation fluid temperature on postoperative complications.MethodsThis randomized controlled trial included 120 consecutive patients undergoing flexible ureteroscopic holmium laser lithotripsy at the Urology Department, Suining Central Hospital, Sichuan, China between January 2017 and July 2019. Patients were randomized 1:1:1 into three groups (17 °C, 27 °C or 37 °C). Primary outcome was fever incidence (body temperature > 37.5 °C) within 48 h after surgery. Secondary outcomes included shivering incidence during recovery from anesthesia, white blood cell count (WBC), serum procalcitonin (PCT) and incidence of suspected infection (temperature > 38.5 °C and PCT > 0.5 µg/L).ResultsThere were 108 patients, (17 °C group, n = 36; 27 °C group, n = 35; 37 °C group, n = 37), received flexible ureteroscopic holmium laser lithotripsy and analyzed. Age, gender distribution, body mass index, ASA grade, stone burden, preoperative creatinine, preoperative core temperature and irrigation fluid volume did not differ significantly between groups. 17 °C, 27 °C and 37 °C groups exhibited significant differences in the incidences of postoperative fever (38.9% vs. 17.1% vs. 13.5%) and shivering (22.2% vs. 5.7% vs. 2.7%) (p < 0.05 for all pairwise comparisons). There was no significant difference of WBC, PCT and incidence of suspected infection in 37 °C or 27 °C group compared with 17 °C group. One case each of flash pulmonary edema and bleeding occurred in 37 °C group.ConclusionWarming the irrigation fluid can reduce the incidence of postoperative fever and shivering, but further studies are needed to determine the optimal temperature.Trial registration The trial was registered at the Chinese Clinical Trials Registry and allocated as ChiCTR2000031683. The trial was registered on 07/04/2020 and this was a retrospective registration.
Highlights
Flexible ureteroscopic holmium laser lithotripsy is used to treat urinary tract calculi, but postopera‐ tive complications include shivering, fever and infection
Enrolment of the study participants Among 120 patients initially randomized to the three study groups, a total of 12 patients were subsequently excluded from the analysis due to refusal to participate in the trial (n = 3), refusal of flexible ureteroscopic holmium laser lithotripsy in favor of extracorporeal shock wave lithotripsy or percutaneous nephrolithotripsy (PCNL) (n = 3), duration of surgery > 90 min (n = 2), ureteral stenosis (n = 2) or nonideal positioning or displacement of the ureteral stent (n = 2)
Preoperative clinical characteristics There were no significant differences between the three groups in age, sex distribution, body mass index (BMI), stone location, stone burden, American Society of Anesthesiologists (ASA) grade or preoperative serum creatinine level (Table 1)
Summary
Flexible ureteroscopic holmium laser lithotripsy is used to treat urinary tract calculi, but postopera‐ tive complications include shivering, fever and infection. A variety of medical [3] and surgical [4, 5] therapies are available for the treatment of urinary calculi, including stone fragmentation by lithotripsy [6]. Ureteroscopes introduced via the urethra can reach upper urinary tract calculi in the ureter, renal pelvis and calyces, permitting holmium laser lithotripsy to be carried out as a treatment [8]. The latest recommendations of the European Association of Urology, which were published in 2019, recommend flexible ureteroscopic lithotripsy as the first-line surgical treatment option for proximal ureteral/renal calculi with a diameter < 20 mm [9]. There is great interest in identifying methods to reduce the incidence of fever after ureteroscopic holmium laser lithotripsy
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