Evaluation of Risk Factors for Fever and Sepsis after Ureteroscopic Lithotripsy: A Prospective Observational Study

Abstract

Introduction: Ureteroscopic Lithotripsy (URS) is gaining popularity for the management of ureteral stones and even renal stones due to its high efficacy and minimal invasiveness. While this procedure is generally considered safe with a low complication rate, febrile Urinary Tract Infection (UTI) after URS is not rare. Aim: The aim of the present study is to analyse the risk factors for sepsis and febrile UTI after URS. Materials and Methods: A prospective observational study was conducted at a tertiary referral centre in Jaipur, Rajasthan, from July 1, 2021, to July 1, 2022. The study included 148 patients with obstructive ureteral stones who underwent Ureteroscopy and Laser Stone Lithotripsy (URSL). The patients were divided into two groups: Group-A consisted of patients who developed urosepsis and fever after URSL, and Group-B consisted of patients who underwent URSL without urosepsis. Various risk factors like history of Percutaneous Nephrolithotomy (PCNL), types and sizes of stones, stone locations, duration of operation, mean catheter removal time, and hospital stays were recorded and compared. Chi-square tests and multifactorial logistic regression analyses were used. Results: The incidence of febrile UTI was 12.16% (18 out of 148 patients). The mean age was 42.2±7.2 years in the postoperative febrile group and 42.75±7.44 years in the postoperative non- febrile group. Statistically significant differences were observed between the groups in terms of stone size (p<0.001), duration of operation (p<0.007), stone number (p=0.002), and stone location (p=0.013), which consequently led to an increase in mean catheter removal time (p<0.001) and length of hospital stay (p<0.001). Conclusion: The present study identified several notable risk factors associated with the development of fever and sepsis following URS. Identifying these factors enables healthcare providers to identify patients who may be at a higher risk of postoperative complications and implement appropriate preventive measures.