Abstract
Background: The aim of this study is to investigate outcomes of pre-operative stent dwell time on infectious complications following ureteroscopy and stone treatment to identify a time cut-off. Material and Methods: Three tertiary referral centres in Europe retrospectively collected outcomes of ureteroscopy and laser fragmentation (URSL) for all patients with pre-operative indwelling ureteric stents over a period of up to 5 years. Data was collected on patient details, stone demographics, stent dwell time, complications and stone free rate (SFR). Matching for age, sex, operative time, stone size and post-operative stent insertion. To examine for a threshold effect, monthly cut-offs were used to compare post-ureteroscopic febrile UTIs. Binomial logistic regression was used (SPSS v.24) with a significance level set at 0.0036. The risk ratio (RR) with a 95% confidence interval (CI) and the number needed to harm (NNH) are reported. Results: There were 467 patients with a pre-operative stent for analysis. These patients (n = 315) were matched to non-stented controls after excluding 152 patients to achieve adequate matching. There was a significant difference in rates of post-ureteroscopic febrile UTI between stented vs non-stented patients (RR = 2.67, 95% CI: 1.10–6.48, p = 0.03). On adjustment, a dwell time of more than two months was associated with an increased risk of post-ureteroscopic febrile UTI (RR = 3.94, 95% CI: 1.30–12.01, p = 0.02), this increased risk rose with longer dwell time. At stent time longer than four months was associated with a significantly increased risk of post-ureteroscopic febrile UTI (5% vs. 15%, RR = 3.09, 95% CI: 1.56–6.10, p = 0.001), with the number needed to harm at 10. Conclusions: Overall infectious complication rates from URSL are low. The risk of post-operative UTI after four months of dwell time is nearly tripled compared to less than four months.
Highlights
Kidney stone disease (KSD) is becoming an increasingly prevalent problem [1]
Investigated post-ureteroscopic complication is urinary tract infection (UTI) [3], which arises in around 5% of all ureteroscopies [4]
152 stented patients were excluded from the stent vs no stent analysis
Summary
Kidney stone disease (KSD) is becoming an increasingly prevalent problem [1]. Surgical practice has changed over the past two decades and ureteroscopy has become one of the most common interventions for KSD [2]. Investigated post-ureteroscopic complication is urinary tract infection (UTI) [3], which arises in around 5% of all ureteroscopies [4]. One of the more consistent risk factors for the development of post-ureteroscopic infection is the presence of a pre-operative stent [4,5,6]. The aim of this study is to investigate outcomes of pre-operative stent dwell time on infectious complications following ureteroscopy and stone treatment to identify a time cut-off. There was a significant difference in rates of post-ureteroscopic febrile UTI between stented vs non-stented patients (RR = 2.67, 95% CI: 1.10–6.48, p = 0.03). At stent time longer than four months was associated with a significantly increased risk of post-ureteroscopic febrile UTI (5% vs 15%, RR = 3.09, 95% CI: 1.56–6.10, p = 0.001), with the number needed to harm at 10. The risk of post-operative UTI after four months of dwell time is nearly tripled compared to less than four months
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