Abstract

BackgroundA history of preoperative obstructive pyelonephritis has been reported as a risk factor for febrile urinary tract infection (fUTI) after ureteroscopic lithotripsy (URSL). But there is no clear evidence of risk factors for developing fUTI including the optimal timing of URSL after obstructive pyelonephritis treatment.MethodsOf the 1361 patients, who underwent URSL at our hospital from January 2011 to December 2017, 239 patients had a history of pre-URSL obstructive pyelonephritis. The risk factors were analyzed by comparing the patients’ backgrounds with the presence or absence of fUTI after URSL. The factors examined were age, gender, body mass index, comorbidity, presence or absence of preoperative ureteral stent, stone position, stone laterality, stone size, Hounsfield unit (HU) value on computed tomography scan, history of sepsis during obstructive pyelonephritis, period from antipyresis to URSL, ureteral stenting period, operation time, and presence or absence of access sheath at URSL. In addition, the stone components and renal pelvic urinary culture bacterial species during pre-URSL pyelonephritis were also examined.ResultsPost-URSL fUTI developed in 32 of 239 patients (13.4%), and 11 of these 32 cases led to sepsis (34.4%). Univariate analysis showed that stone position, stone maximum HU value, presence of sepsis during obstructive pyelonephritis, period from antipyresis to URSL, pre-URSL ureteral stent placement, operation time were risk factors of fUTI. Stone components and urinary cultures during pyelonephritis were not associated with risk of fUTI. Multivariate analysis showed that renal stone position, pre-URSL ureteral stent placement > 21 days, and operation time > 75 min were independent risk factors of fUTI following the URSL.ConclusionsF-UTI following the URSL could be avoided by ureteral stent placement period 21 days or less and operation time 75 min or less in patients with obstructive pyelonephritis.

Highlights

  • A history of preoperative obstructive pyelonephritis and ureteral stent placement has been reported as a risk factor for febrile urinary tract infection after ureteroscopic lithotripsy (URSL) [5, 6]

  • There were no significant differences in age, sex, body mass index (BMI), comorbidities, or stone size between the two groups. 149 patients used ureteral access sheath (UAS) during URSL, 140 patients (94.0%) were 12/14 Fr, 9 patients (6.0%) were 10/12 Fr, and there was no significant difference in post-URSL

  • The febrile urinary tract infection (fUTI) group presented with renal stones at URSL, had a higher maximal Hounsfield unit (HU) value, higher incidence of concurrent sepsis during

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Summary

Introduction

A history of preoperative obstructive pyelonephritis has been reported as a risk factor for febrile urinary tract infection (fUTI) after ureteroscopic lithotripsy (URSL). A history of preoperative obstructive pyelonephritis and ureteral stent placement has been reported as a risk factor for febrile urinary tract infection (fUTI) after ureteroscopic lithotripsy (URSL) [5, 6]. It has not been established whether URSL can be safely performed after renal drainage; there are concerns that URSL may cause post-URSL fever or sepsis due to increased renal pressure. The purpose of this study is to establish the optimal timing of URSL and risk factors for fUTI following URSL in patients with obstructive pyelonephritis

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