Postoperative infection after ureterorenoscopic lithotripsy in Songkhla Hospital

Abstract

Objective: Ureterorenoscopic lithotripsy (URSL) is the procedure of choice for treatment of ureteral stones. Postoperative acute pyelonephritis (APN) is a serious complication after URSL which may potentially progress to urosepsis and death. In this study we aimed to explore and record potential predictive factors associated with postoperative APN after URSL. Materials and Methods: Ninety patients (2016-2022) with ureteral stone managed with URSL were identified. Postoperative APN was defined in patients with a body temperature > 38 °C which persisted for at least 48 hours after URSL with clinical symptoms and/or urine culture was positive for organism growth. Multivariable analysis with logistic regression was used to identify predictive factors for postoperative APN. Results: Seven patients (7.8%) experienced postoperative APN and six patients (85.7%) developed systemic inflammatory response syndrome. All patients were managed conservatively with selective antibiotics, specifically treated with meropenem (n = 3), piperacillin/tazobactam (n = 3), and imipenem/cilastatin (n = 1). Most patients with postoperative APN were women (5/7 patients, 71.4%). The median age of the seven postoperative APN patients was 57.6 vs 54 years (p = 0.48) and the hospital stay was longer 5 vs 2 days, (p < 0.01). Preoperative APN was found in 12 patients (13.3%) and six patients (50%) developed perioperative APN. The multivariable analysis, showed that the only independent factor of postoperative APN was a history of preoperative APN Conclusion: Postoperative infection is a serious condition after URSL that can increase the risk of morbidity and mortality. A single significant risk factor for postoperative infection was a history of preoperative APN. These patients should receive rigorous postoperative care to avoid serious complications.