MP68-03 UROSEPSIS FOLLOWING URETERORENOSCOPY FOR THE TREATMENT OF UROLITHIASIS OR UPPER URINARY TRACT TRANSITIONAL CELL CARCINOMA: A FOCUS ON UNDERESTIMATED AND HARMFUL POSTOPERATIVE COMPLICATION

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy VI1 Apr 2017MP68-03 UROSEPSIS FOLLOWING URETERORENOSCOPY FOR THE TREATMENT OF UROLITHIASIS OR UPPER URINARY TRACT TRANSITIONAL CELL CARCINOMA: A FOCUS ON UNDERESTIMATED AND HARMFUL POSTOPERATIVE COMPLICATION Luca Villa, Filippo Pederzoli, Francesco Trevisani, Alberto Briganti, Andrea Salonia, and Francesco Montorsi Luca VillaLuca Villa More articles by this author , Filippo PederzoliFilippo Pederzoli More articles by this author , Francesco TrevisaniFrancesco Trevisani More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , and Francesco MontorsiFrancesco Montorsi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2319AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The reported rate of infectious complications following ureterorenoscopy (URS) for the treatment of patients with either urinary stones or low-risk upper urinary tract transitional cell carcinoma (UUT-TCC) is reasonably low. We investigated the rate of urosepsis following URS in our series and looked for predictors of postoperative infectious events. METHODS We identified 99 patients submitted to URS with intracorporeal holmium:YAG laser lithotripsy for ureteral and/or renal stones (n=71) or with laser tumour photoablation for suspicion of UUT-TCC (n=28) throughout the last 12 consecutive months. A preoperative urine culture was routinely obtained and any concomitant urinary tract infection (UTI) was treated prior surgery. Antibiotic prophylaxis (i.e., second generation cephalosporin) was offered preoperatively. A ureteral access sheath 10/12 Fr was used when an intrarenal procedure was scheduled. Descriptive statistics was used to detail clinical features of the whole cohort of patients. Urosepsis was defined using the Third International Consensus Definitions for Sepsis and Septic Shock. Chi-square and independent T-test assessed differences among patients with and without urosepsis following URS. All tests were two-sided with a significance level set at p < 0.05. RESULTS 89 patients (89.9%) had elective admission to our department, and 10 patients (10.1%) were admitted through the emergency room. Seven patients (7.1%) developed urosepsis, four (4%) advanced to septic shock, and one (1%) eventually died. Patients who developed urosepsis compared with their counterparts who did not develop urosepsis more frequently had a stone or tumour in the intrarenal cavities rather than in the ureter (100% vs. 50%, respectively), a previous history of UTI (57.1 % vs. 13%, respectively), access to our department through the emergency room (42.8% vs. 7.6%, respectively), longer hospital stay prior to surgery (mean = 6 vs. 0.5 days, respectively), and higher burden of comorbid conditions (Charlson Comorbidity Index ≥3 = 43.8% vs. 18.4%, respectively) (all p< 0.01). Conversely, the rate of urosepsis following URS for the treatment of stones and UUT-TCC did not vary significantly (5.6% and 10.7%, respectively; p=0.4). CONCLUSIONS Proper counselling of patients candidate to URS for either ureteral/renal stones or UUT-TCC who have comorbid conditions or certain clinical features is mandatory, as the risk of severe urosepsis in these categories of patients is not negligible. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e919 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Luca Villa More articles by this author Filippo Pederzoli More articles by this author Francesco Trevisani More articles by this author Alberto Briganti More articles by this author Andrea Salonia More articles by this author Francesco Montorsi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...