Positive Preoperative Urine Culture Research Articles

Influence of preoperative urine culture and bacterial species on urogenital sepsis after ureteral flexible lithotripsy in patients with upper urinary tract stones.

This retrospective study aims to identify risk factors for urogenic sepsis in patients with upper urinary tract stones following ureteral flexible lithotripsy (FURL). Additionally, we analyze the clinical characteristics of bacterial infections post-surgery. A total of 759 patients who underwent FURL at the Urology Department of Zunyi Medical University were included. Univariate and multivariate Logistic regression analyses were conducted to identify independent risk factors for urogenic sepsis post-FURL. The distribution of bacteria based on preoperative urine cultures was also analyzed. Statistical analysis was performed using R4.2.2 software. Of the 759 patients, positive preoperative urine culture, urine nitrite positivity, urine white blood cell count (WBC) ≥ 200 cells/μL, residual stones, and neutrophil-to-lymphocyte ratio (NLR) were found to be independent risk factors for urogenic sepsis after FURL. Among the 164 patients with positive preoperative urine cultures, 32 developed urogenic sepsis post-surgery, with 68.75% having positive preoperative cultures. The leading pathogens causing postoperative urogenic sepsis were Escherichia coli (E. coli), Enterococcus faecium, Proteus mirabilis, and Klebsiella pneumoniae. The probabilities of progression to urogenic sepsis were as follows: E. coli 19% (n = 12), Enterococcus faecium 43% (n = 3), Proteus mirabilis 33.3% (n = 1), and Klebsiella pneumoniae 33.3% (n = 1). The ages of affected patients were 47.17 ± 13.2, 53.7, 41, and 79 years, respectively. Rates of comorbid diabetes were 36.4, 66.7, 50, 100%, with nitrite positivity rates at 72.7, 33.3, 50, 0%. Ten female patients were infected with E. coli, while patients infected with Klebsiella pneumoniae had an NLR of 7.62. Positive preoperative urine culture, urine nitrite positivity, urine WBC ≥ 200 cells/μL, residual stones, and NLR are independent risk factors for urogenic sepsis after FURL. Escherichia coli is the predominant pathogen post-FURL, with notable female prevalence and nitrite-positive urine in infections. Enterococcus faecium infections are associated with diabetes.

Critically Evaluating the Role for Postoperative Antibiotics in Patients Undergoing Urethroplasty With Buccal Mucosa Graft: A Claims Database Analysis

ObjectivesTo compare outcomes among patients undergoing first-time urethroplasty with buccal mucosa graft (BMG) who receive post-operative antibiotics versus those who do not. MethodsA retrospective cohort study was conducted using the TriNetX claims database between 2008-2022. Using CPT, ICD10, and LOINC codes, patients >18 years old undergoing primary urethroplasty with BMG who received an outpatient prescription for antibiotics between post-operative day 0-30 or did not were queried. Patients with positive pre-operative urine culture or urinary tract infection (UTI) within 30 days pre-operatively were excluded. Surgical outcomes included 5-year revision rates and revision-free survival. Safety outcomes included new UTI within 30 days, surgical site infection (SSI) within 90 days, or Clostridium difficile infection within 30 days of urethroplasty. ResultsWe identified 884 patients (81% antibiotic cohort, 19% non-antibiotic cohort) that met inclusion criteria. Age at time of urethroplasty, suprapubic tube presence, and pre-existing medical comorbidities were comparable between cohorts (Table 1A). There was no difference in 5-year rates and revision-free survival for endoscopic revision (11.5% vs. 9.5%, RR 1.2, 95% CI [0.7, 2.0], RFS log-rank p=0.6), re-do urethroplasty (12.9% vs. 13.7%, RR 0.9, 95% CI [0.6, 1.5], RFS log-rank p=0.7), or all-cause revision (19.8% vs. 17.7%, RR 1.1, 95% CI [0.8, 1.6], p=0.5) between groups. Post-operative rates of UTI, SSI, and Clostridium difficile infection were similar between groups. ConclusionsIn this large retrospective cohort study of patients undergoing urethroplasty with BMG, we observed no significant benefit from use of post-operative antibiotics on long-term revision rates or perioperative infectious complications.

Construction and validation of the nomogram predictive model for post-percutaneous nephrolithotomy urinary sepsis.

This study aimed to construct and validate a simple and accurate clinical nomogram for predicting the occurrence of post-percutaneous nephrolithotomy sepsis, aiming to assist urologists in the early identification, warning, and early intervention of urosepsis, and to provide certain evidence-based medicine basis. This study included patients who underwent PCNL surgery due to kidney or upper ureteral stones at the Department of Urology, Affiliated Hospital of Zunyi Medical University, from January 2019 to September 2022. This study utilized univariate and multivariate logistic regression analysis to screen and evaluate the risk factors for sepsis and construct a predictive model. An evaluation was performed using the receiver operating characteristic curve, calibration curve, and decision curve analysis curve. All statistical analyses were conducted using R version 4.2. A total of 946 patients who underwent post-PCNL were included in this study, among whom 69 patients (7.29%) developed post-PCNL urinary sepsis. Multiple-factor logistic regression analysis identified four independent risk factors associated with post-PCNL urinary sepsis, including positive urinary nitrite (OR = 5.9, P < 0.001), positive urine culture (OR = 7.54, P < 0.001), operative time ≥ 120min (OR = 20.93, P = 0.0052), and stone size ≥ 30mm (OR = 13.81, P = 0.0015). The nomogram model demonstrated good accuracy with an AUC value of 0.909, and in the validation cohort, the AUC value was 0.922. The calibration curve indicated a better consistency between the predictive line chart and the actual occurrence of post-PCNL urinary sepsis. The decision curve analysis curve showed favorable clinical utility. Preoperative positive urine culture, positive urinary nitrite, operative time ≥ 120min, and stone size ≥ 30mm are independent risk factors for developing post-PCNL urinary sepsis. The constructed line chart based on these factors effectively assesses the risk of urinary sepsis in patients after PCNL.

Assessment of the incidence and risk factors of postoperative urosepsis in patients undergoing ureteroscopic lithotripsy.

Ureteroscopic lithotripsy (URSL) is an approved, minimally invasive, low-risk procedure for urolithiasis treatment. However, some patients may develop urinary tract infection (UTI) post-procedure, eventually leading to urosepsis. Determining the predictors of infection after URSL would help identify patients at a high risk of urosepsis, thereby enabling the early implementation of effective treatment. Therefore, we aimed to establish the incidence and predictors of urosepsis after URSL. We assessed 231 patients who underwent URSL using a holmium laser. The incidence of urosepsis during the 30-day post-treatment period was analysed, and potential predictors of urosepsis, including patient characteristics and individual clinical factors, were examined. Statistical analysis revealed that 16.88% of patients had a confirmed positive urine culture before the procedure. Post-procedure urosepsis occurred in 4.76% of patients. Univariable analysis revealed that 3 factors were significantly associated with the risk of postoperative urosepsis: double-J stent insertion before URSL, pre-operative positive urine culture, and MDR pathogen found preoperatively. In multivariable analysis, only positive urine culture remained significantly associated with the risk of urosepsis after URSL. Patients with positive urine culture before URSL are at significantly higher risk of urosepsis in the postoperative period. Hence, urine culture should be routinely performed before planned endoscopic urolithiasis treatment.

Predictors of febrile urinary tract infection after ureterorenoscopy for urinary stones

Background: Ureterorenoscopy is a frequently used technique for the treatment of urolithiasis which provides high success rates when used under proper indications. Febrile urinary tract infection (FUTI) and urinary sepsis is the most frequent among its scarce complications. It often results secondary to urinary tract obstruction associated with urolithiasis, but also may occur after urinary tract manipulation such as ureterorenoscopy, clinical presentation varies from self-limited fever to the development of septic shock with the need for vasoactive agents or even to the patient’s death. This study has been designed to determine our rate of postoperative FUTI and sepsis after ureterorenoscopy, as well as to identify those factors that have been associated with its development. Method: Prospective study done on 219 patients who underwent ureterorenoscopy for urinary lithiasis in government medical college, Kottayam from February 2021-March 2022. Personal, clinical, surgical and microbiological data were collected. Patients who develop FUTI, urinary sepsis during 30 days following intervention were identified. Statistical analysis will be performed by chi squared test/fishers exact test; logistic regression as appropriate. Results: Our studies show incidence rates of postoperative FUTI in 11% and sepsis in 1.3%. Following statistical analysis, it was discovered that double J urinary diversion, a positive preoperative urine culture, diabetes, prolonged operational time, and intraoperative dilatation were all high-risk factors for the development of UTI after instrumentation. Conclusions: Ureteroscopy-associated urosepsis is a nosocomial infection. With the increasing popularity of ureteroscopic procedures, it is imperative that patients with increased risk are addressed appropriately, and suspected sepsis must be speedily and aggressively managed.

Preoperative Frailty Scores Predict the Early Postoperative Complications of Holmium Laser Enucleation of Prostate.

Background: Frailty is a recent multidimensional concept of a contemporary growing interest for understanding the complex health status of elderly population. We aimed to assess the impact of frailty scores on the outcome and complication rate of holmium laser enucleation of prostate (HoLEP). Methods: A 7-year data of HoLEP patients in a single tertiary referral center were reviewed. The preoperative, operative, early, and late postoperative outcome data were collected and compared according to the preoperative frailty scores. Frailty was assessed preoperatively using the Modified Hopkins frailty score. Results: The study included 837 patients categorized into two groups: group I included 533 nonfrail patients (frailty score = 0), whereas group II included 304 frail patients (frailty score ≥1). The median (interquartile range) age was 70 (11) and 75 (11) years for groups I and II, respectively (<0.001). The 30-day perioperative complication rate (p = 0.005), blood transfusion (p = 0.013), failed voiding trial (p = 0.0015), and 30-day postoperative readmission (p = 0.0363) rates were significantly higher in frail patients of group II. The two groups were statistically comparable regarding postoperative international prostate symptom score (p = 0.6886, 0.6308, 0.9781), incontinence rate (p = 0.475, 0.592, 0.1546), postvoid residual (p = 0.5801, 0.1819, 0.593) at 6 weeks and 3 months, and 1-year follow-up intervals, respectively. Conclusion: In elderly patients undergoing HoLEP, the preoperative frailty scores strongly correlate with the risk of perioperative complications. Frail patients should be counseled regarding their relative higher risk of early perioperative complications although they gain the same functional profit of HoLEP as nonfrail patients.

Does prophylactic antibiotics post pediatric pyeloplasty reduce the incidence of febrile UTIs?

PurposeThe use of postoperative prophylactic antibiotics in pediatric upper urinary tract reconstruction remains controversial. In this study, we examined whether low dose antibiotics administered following pediatric pyeloplasty reduce the incidence of febrile urinary tract infections at our institution. As a secondary outcome, in those patients with infection, additional analysis was performed to better quantify which patient population benefits the most from low dose prophylactic antibiotics.MethodsInstitutional review board approval (IRB) was obtained. All methods were carried out in accordance with relevant guidelines and regulations. A retrospective study was performed in patients who underwent pyeloplasty (2011–2017) at our institution. Surgical approach (laparoscopic versus robotic assisted versus open, with or without internal JJ ureteral stent) were based on surgeon preference. Patients of 8 fellowship trained pediatric urologists were included in the study period. Patients with prior history of urologic interventions or other congenital genitourinary tract abnormalities were excluded. Demographics (age, gender, ethnicity, insurance status), prior history of culture proven urinary tract infection, surgical details (administration of perioperative antibiotics), and postoperative outcomes including; 1) re-admission 30 days post-surgery, 2) any urine cultures collected due to suspected urinary tract infection.ResultsA total of 209 patients (149 boys, 60 girls) met our inclusion criteria with 55/209 (26%) receiving postoperative prophylactic antibiotics. The average age was 6 years (range: 2 months-18 years). Indwelling ureteral stent was used in 176 (84%) patients. Eleven patients (5%) had a culture-proven urinary tract infection within 30-days postoperatively. No significant differences were seen in postoperative complications or incidence of urinary tract infection when comparing surgical approaches, +/- ureteral stent, or the use of antibiotics. Secondary analysis noted statistically significant increase in post-operative urinary tract infection in younger children (2.8 v. 6.2 years, p = 0.02), those patients who had a positive preoperative urine culture (8/11, p = 0.01) and those with public health insurance (p = 0.038).ConclusionThe incidence of postoperative urinary tract infection following pyeloplasty in our cohort was relatively low. There was a higher incidence of urinary tract infection in patients less than 3 years old. The use of antibiotics in patients post pyeloplasty did not appear to affect the incidence of post-operative urinary tract infection, however, they may have a role in children who have not yet potty trained and in patients with positive preoperative urine culture.

Predictors of postoperative urinary tract infection following holmium laser enucleation of the prostate.

Storage urinary symptoms and urinary tract infection (UTI) are among the most common complications following holmium laser enucleation of the prostate (HoLEP). We aimed to study the incidence and risk factors for storage urinary symptoms and early UTI following HoLEP. A prospectively maintained database was reviewed for patients who underwent HoLEP over a five-year period at a single tertiary center. Patient demographics, preoperative, operative, and postoperative characteristics, as well as infection rates, were obtained and analyzed using the appropriate statistical methods. Of a total 514 patients who underwent HoLEP, 473 patients with complete followup data were included. Mean (± standard deviation) age and median (interquartile range) prostate volume were 72±9.1 years and 89 (68-126) g, respectively. Preoperative positive urine culture and urine retention were seen in 28.5% (n=135) and 23.46 % (n=111) of patients, respectively. At six-week followup, irritative urinary symptoms were seen in 32.3% (n=153) of patients, while 13.5% (n= 64) of patients had positive urine culture. Bivariate and multivariate analysis showed that factors associated with significant higher rate of postoperative UTI at six weeks were high body mass index (BMI) (p= 0.023), weak grip strength within preoperative frailty assessment (p=0.042), positive preoperative urine culture (p=0.025), and postoperative incontinence (p=0.002). Storage urinary symptoms are common complaints post-HoLEP; however, it may be caused by an inflammatory rather than infective process in a significant percentage of patients. Possible predictors of UTI after HoLEP are high BMI, preoperative positive urine culture, higher frailty scale, and postoperative urinary incontinence.

The Mayo adhesive probability score predicts postoperative fever and intraoperative hemorrhage in mini-percutaneous nephrolithotomy.

Contemporary predictive tools for miniaturized percutaneous nephrolithotomy (mPCNL) mainly focus on stone clearance but not perioperative complications, especially infection and hemorrhage. This study aimed to evaluate whether the Mayo adhesive probability (MAP) score, an index of the perinephric fat characteristics, can predict postoperative fever and intraoperative hemorrhage in mPCNL. This is a retrospective study recruiting 159 mPCNL patients from July 2018 to January 2022. MAP scores were recorded using preoperative computed tomography. Postoperative complications included postoperative fever and intraoperative bleeding, defined as hemoglobin drop. Over half patients had the MAP score ≧ 3. Men, elderly, chronic kidney disease, and diabetes were associated with a higher MAP score. The patients with a higher MAP score were more likely to have postoperative fever after mPCNL. On multivariate analysis, preoperative positive urine culture (OR 2.68) and a higher MAP score (OR 2.28) were both significantly associated with postoperative fever. ROC curves analysis of the combination of these two factors on predicting postoperative fever showed AUC values were 0.731 (0.652-0.810). Moreover, a higher MAP score (OR 2.30) and longer operative time (OR 2.16) were significantly associated with higher hemoglobin drop on multivariate analysis. A high MAP score was associated with postoperative fever and intraoperative hemorrhage in patients undergoing mPCNL. The MAP score can be a novel and easy predictive tool to help endourologists improve the awareness of mPCNL safety.

Role of Ureteroscopy (URS) and Stone Treatment in Patients with Recurrent UTIs: Outcomes over a 10-Year Period.

Background. The study aimed to assess whether the eradication of kidney stones might result in a substantial reduction in the onset of recurrent UTIs. Methods. We selected all the patients who underwent ureteroscopy (URS) for stone disease between 2012 and 2021, with either a history of recurrent UTIs (rUTIs), urosepsis or pre-operative positive urine culture (UC). Data included patient demographics, microbiological data, stone parameters, stone-free and infection-free rates (SFR and IFR, respectively) at follow-up, defined as fragments <2 mm at imaging and the absence of symptoms and urine-culture-proven UTI. Results. Overall, 178 patients were selected. The median age was 62 years. The median cumulative stone size was 10 mm (7-17.25), and the commonest locations were the lower pole (18.9%) and proximal ureter (14.9%). The overall stone-free rate at follow-up was 89.3%. The IFR at 3 months was 88.3%. As follow-up duration increased, the IFR reduced to 85.4%, 74.2%, 68% and 65% at 6, 12, 18 and 24 months, respectively. Patients who had infection recurrence were more likely to present stone persistence or recurrence compared to those who were infection-free at follow-up (20% vs. 4.4%, p = 0.005). Conclusions. SFR after URS is a significant predicting variable for the likelihood of infection-free status at follow-up in patients with an rUTI or positive UC at the time of URS.

Safety of Omitting Preoperative Antibiotic Prophylaxis in Patients Undergoing Transurethral Ureterolithotripsy

Background: Transurethral ureterolithotripsy (TUL) is a common and highly efficient procedure for treating ureteral stones. The need for preoperative antibiotic prophylaxis to prevent post-TUL infections remains controversial. Objectives: This study aimed to investigate whether the removal of preoperative antibiotic prophylaxis affects the rate of postoperative complications in patients undergoing TUL. Methods: A total of 62 patients (aged 15-65 years) undergoing TUL between November 2021 and March 2022 were included in this controlled clinical trial. Patients were divided into two groups by the available gradual and sequential sampling methods: 33 had positive preoperative urine culture (UC), and 29 had negative preoperative UC. None of the patients in the two groups received preoperative antibiotic prophylaxis. Perioperative and postoperative outcomes, such as the operative time, stone-free rate, postoperative analgesic use, fever, urinary tract infection (UTI), and hospital stay, were reviewed in both groups. Results: Patients with positive UC were significantly older than those with negative UC (P=0.018), and had a higher BMI (P=0.016). No significant differences were observed between the two groups in most perioperative variables or postoperative outcomes (P&gt;0.05). In addition, patients in the positive UC group had significantly more underlying diseases than the other group (P=0.022). Postoperative symptomatic UTI was found in neither of the two groups. Fever was reported in 3 (9.1%) and 1 (3.4%) patients in the positive and negative UC groups, respectively, with no statistically significant differences between the two groups (P=0.616). In the matched logistic regression model, the effect of preoperative UC on postoperative fever was not significant (P=0.40). Conclusion: The results of our study showed that prophylactic antibiotics can be eliminated at the discretion of the surgeon in patients without symptomatic positive UC.

Risk factors for bladder neck contracture after transurethral resection of the prostate.

Transurethral resection of the prostate (TURP) is the most frequently used treatment of benign prostate hyperplasia with a prostate volume of <80 mL. A long-term complication is bladder neck contracture (BNC). The aim of the present study was to identify the risk factors for BNC formation after TURP. We conducted a retrospective analysis of all TURP primary procedures which were performed at one academic institution between 2013 and 2018. All patients were analyzed and compared with regard to postoperative formation of a BNC requiring further therapy. Uni- and multivariable logistic regression analyses (MVAs) were performed to identify possible risk factors for BNC development. We included 1368 patients in this analysis. Out of these, 88 patients (6.4%) developed BNC requiring further surgical therapy. The following factors showed a statistically significant association with BNC development: smaller preoperative prostate volume (p = 0.001), lower resected prostate weight (p = 0.004), lower preoperative levels of prostate-specific antigen (PSA, p < 0.001), shorter duration of the surgery (p = 0.027), secondary transurethral intervention (due to urinary retention or gross hematuria) during inpatient stay (p = 0.018), positive (≥100 CFU/mL) preoperative urine culture (p = 0.010), and urethral stricture (US) formation requiring direct visual internal urethrotomy (DVIU) postoperatively after TURP (p < 0.001), in particular membranous (p = 0.046) and bulbar (p < 0.001) strictures. Preoperative antibiotic treatment showed a protective effect (p = 0.042). Histopathological findings of prostate cancer (PCA) in the resected prostate tissue were more frequent among patients who did not develop BNC (p = 0.049). On MVA, smaller preoperative prostate volume (p = 0.046), positive preoperative urine culture (p = 0.021), and US requiring DVIU after TURP (p < 0.001) were identified as independent predictors for BNC development. BNC is a relevant long-term complication after TURP. In particular, patients with a smaller prostate should be thoroughly informed about this complication.

Risk factors for systemic inflammatory response syndrome after endoscopic lithotripsy for upper urinary calculi

BackgroundTo explore the risk factors for systemic inflammatory response syndrome (SIRS) after endoscopic lithotripsy for upper urinary calculi.MethodsThis retrospective study included patients with upper urinary calculi who underwent endoscopic lithotripsy in the First Affiliated Hospital of Zhejiang University between June 2018 and May 2020.ResultsA total of 724 patients with upper urinary calculi were included. One hundred and fifty-three patients developed SIRS after the operation. The occurrence of SIRS was higher after percutaneous nephrolithotomy (PCNL) compared with ureteroscopy (URS) (24.6% vs. 8.6%, P < 0.001) and after flexible ureteroscopy compared with ureteroscopy (fURS) (17.9% vs. 8.6%, P = 0.042). In the univariable analyses, preoperative infection history (P < 0.001), positive preoperative urine culture (P < 0.001), history of kidney operation on the affected side (P = 0.049), staghorn calculi (P < 0.001), stone long diameter (P = 0.015), stone limited to the kidney (P = 0.006), PCNL (P = 0.001), operative time (P = 0.020), and percutaneous nephroscope channel (P = 0.015) were associated with SIRS. The multivariable analysis showed that positive preoperative urine culture [odds ratio (OR) = 2.23, 95% confidence interval (CI): 1.18–4.24, P = 0.014] and operative methods (PCNL vs. URS, OR = 2.59, 95% CI: 1.15–5.82, P = 0.012) were independently associated with SIRS.ConclusionPositive preoperative urine culture and PCNL are independent risk factors for SIRS after endoscopic lithotripsy for upper urinary calculi.

MP51-20 PREDICTORS OF URINARY TRACT INFECTION POST-HOLMIUM LASER ENUCLEATION OF PROSTATE (HOLEP)

You have accessJournal of UrologyCME1 Apr 2023MP51-20 PREDICTORS OF URINARY TRACT INFECTION POST-HOLMIUM LASER ENUCLEATION OF PROSTATE (HOLEP) Mohamed Elsaqa, Katherine Dowd, Amr Elmekresh, and Marawan M. El Tayeb Mohamed ElsaqaMohamed Elsaqa More articles by this author , Katherine DowdKatherine Dowd More articles by this author , Amr ElmekreshAmr Elmekresh More articles by this author , and Marawan M. El TayebMarawan M. El Tayeb More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Irritative urinary symptoms and urinary tract infection (UTI) are among the most common complications following Holmium Laser Enucleation of Prostate (HoLEP). We aimed to study the incidence and risk factors for early irritative urinary symptoms and postoperative UTI post-HoLEP. METHODS: A maintained HoLEP database of over 5 years at our institution was reviewed. Patients' demographics, perioperative characteristics, post-operative irritative symptoms, and UTI rates (defined by irritative symptoms with positive urine culture) were analyzed. RESULTS: Total 473 patients with complete follow-up data were included. Tables 1 and 2 show the baseline and postoperative data of included patients respectively. Preoperative positive urine culture and urine retention were seen in 128 (27%) and 111 (23.4%) patients respectively. At 6-week follow-up, irritative urinary symptoms were reported by 153 (32.3%) patients, while urine culture was positive in only 64 (13.5%) patients. Multivariate analysis showed that high body mass index (BMI) (HR=2.02; CI=1.36-2.58, p=0.023), weak grip strength within preoperative frailty assessment (HR=1.36; CI=1.06-2.13, p=0.042), preoperative positive urine culture (HR=1.92; CI=1.3-3.38, p=0.025) and postoperative incontinence (HR=2.82; CI=1.8-5.67, p=0.002) were associated with statistically significant risk of positive urine within 1st 6 weeks post-HoLEP. CONCLUSIONS: Irritative urinary symptoms are common complaints post-HoLEP; however, it may be caused by inflammatory rather than infective process in significant percentage of patients. Irritative Symptoms can be associated with over-treatment with empirical antibiotics. Possible predictors of early UTI post-HoLEP are high BMI, preoperative positive urine culture, higher frailty scale, and postoperative urinary incontinence. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e701 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Elsaqa More articles by this author Katherine Dowd More articles by this author Amr Elmekresh More articles by this author Marawan M. El Tayeb More articles by this author Expand All Advertisement PDF downloadLoading ...

PD45-11 DOES THE USE OF A URETERAL ACCESS SHEATH REDUCE INFECTION-RELATED HOSPITALIZATION? REAL-WORLD DATA FROM A SURGICAL COLLABORATIVE

You have accessJournal of UrologyCME1 Apr 2023PD45-11 DOES THE USE OF A URETERAL ACCESS SHEATH REDUCE INFECTION-RELATED HOSPITALIZATION? REAL-WORLD DATA FROM A SURGICAL COLLABORATIVE Russelle. N. Becker, Andrew M. Higgins, Golena Fernandez Moncaleano, Sung Yong Cho, Mohammad Jafri, Jessica Phelps, Jeremy Konheim, Bronson Conrado, Monica S. Van Til, Stephanie Daignault-Newton, Casey A. Dauw, Khurshid R. Ghani, and For The Michigan Urological Surgery IMPROVEMENT Collaborative Russelle. N. BeckerRusselle. N. Becker More articles by this author , Andrew M. HigginsAndrew M. Higgins More articles by this author , Golena Fernandez MoncaleanoGolena Fernandez Moncaleano More articles by this author , Sung Yong ChoSung Yong Cho More articles by this author , Mohammad JafriMohammad Jafri More articles by this author , Jessica PhelpsJessica Phelps More articles by this author , Jeremy KonheimJeremy Konheim More articles by this author , Bronson ConradoBronson Conrado More articles by this author , Monica S. Van TilMonica S. Van Til More articles by this author , Stephanie Daignault-NewtonStephanie Daignault-Newton More articles by this author , Casey A. DauwCasey A. Dauw More articles by this author , Khurshid R. GhaniKhurshid R. Ghani More articles by this author , and For The Michigan Urological Surgery IMPROVEMENT Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003358.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Elevated intrarenal pressure during ureteroscopy (URS) may result in pyelovenous backflow, which is hypothesized to increase the risk of sepsis. When treating renal stones, the ureteral access sheath (UAS) is considered a pressure mitigation strategy, yet evidence on whether a UAS reduces infectious complications is unclear. Prior studies are limited by small cohorts, heterogenous inclusion criteria, ambiguous endpoints, or lack adequate risk adjustment. We examined UAS use when treating renal stones and its association with infection-related hospitalization in a statewide registry. METHODS: Using the Michigan Urological Surgery Improvement Collaborative (MUSIC) registry, we identified all patients undergoing single-stage unilateral URS for renal stones, with or without the use of a UAS. We assessed variation in UAS in practices with>10 cases. We evaluated demographic differences between cases with or without UAS. A multivariable logistic regression model was constructed to examine the impact of UAS use and other patient, stone, and surgical factors on 30-day infection-related hospitalization. RESULTS: Among 6,142 patients undergoing URS by 233 urologists across 34 practices, 152 (2.5%) had an infection-related hospitalization within 30 days. Patients with UAS had significantly larger stones, more positive preoperative urine culture, and higher comorbidity. Overall 59% of cases utilized UAS, with significant variation between practices (4.1% to 99.5%, p<0.0001; Figure). Infection-related hospitalization rates were no different for cases with (2.6%) vs. without (2.3%) UAS use (p=0.5). On multivariable analysis, infection-related hospitalizations did not differ by UAS (OR 0.8; 95% CI 0.6 - 1.2; p=0.4), but were associated with higher Charlson Comorbidity Index (CCI 1 vs. 0, OR 1.9; 95% CI 1.2 - 2.9; CCI 2+ vs. 0, OR 2.3; 95% CI 1.4 - 3.6; p<0.001), history of recurrent UTI (OR 2.4; 95% CI 1.4 - 4.0; p<0.01), larger stones (OR per 5mm 1.1; 95% CI 1.0 - 1.3; p=0.04), and positive preoperative urine culture (OR 1.8; 95% CI 1.2 - 2.7; p<0.01). CONCLUSIONS: Utilization of UAS when treating renal stones varies widely across practices within Michigan. UAS did not reduce infection-related hospitalization following URS for renal stones. Source of Funding: Blue Cross Blue Shield of Michigan © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1167 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Russelle. N. Becker More articles by this author Andrew M. Higgins More articles by this author Golena Fernandez Moncaleano More articles by this author Sung Yong Cho More articles by this author Mohammad Jafri More articles by this author Jessica Phelps More articles by this author Jeremy Konheim More articles by this author Bronson Conrado More articles by this author Monica S. Van Til More articles by this author Stephanie Daignault-Newton More articles by this author Casey A. Dauw More articles by this author Khurshid R. Ghani More articles by this author For The Michigan Urological Surgery IMPROVEMENT Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...

MP16-11 CARBONATE APATITE NEPHROLITHIASIS

You have accessJournal of UrologyCME1 Apr 2023MP16-11 CARBONATE APATITE NEPHROLITHIASIS Nick Dean, Jenny Guo, and Amy Krambeck Nick DeanNick Dean More articles by this author , Jenny GuoJenny Guo More articles by this author , and Amy KrambeckAmy Krambeck More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003236.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Carbonate apatite (CA) stones are commonly referred to as infection stones given their formation in the presence of bacterial infection and their association with positive urine and stone cultures. Anecdotally at our institution, we observed patients who were found to have CA stones on post-operative stone analysis without positive stone cultures, positive pre-operative urine cultures, or a history of urinary tract infections (UTIs). The aim of our study is to characterize patients with CA stones, with and without evidence of infection, and examine their clinical outcomes. METHODS: We retrospectively identified patients in our prospectively maintained stone database who had undergone surgical treatment for calculi containing CA on final stone analysis. SPSS was used to perform descriptive statistics and two-tailed T tests (p<0.05). RESULTS: We identified 53 patients with CA stones from our database. Most patients were female (n=35, 66.0%) and had undergone percutaneous nephrolithomy (PCNL) (n=44, 83.0%). Mean follow-up was 13.8 months. Almost all patients with CA stones had a documented vitamin D deficiency (n=47, 88.7%) and were prescribed vitamin D supplementation (n=46, 86.8%). Patients had a mean pre-operative stone burden of 2.8 cm (range 0.5-20 cm) and over half of the patients had a positive pre-operative urine culture, post-operative stone culture, or history of UTIs (n=28, 52.8%). Patients with evidence of infection (infection stones) were more likely to have a GU anatomical abnormality (39% vs 4%, p<0.002), greater proportion of CA on stone analysis (51% vs 32%, p=0.037), hypocitraturia on 24-hour urine collection (85% vs 50%, p=0.06), and lower rates of freedom from next stone procedure (82% vs 96%, p=0.12). Patients with infection CA stones did not have longer lengths of stay, worse stone free rates, greater rates of ER presentations, or re-admission rates (all p>0.05) compared to patients without evidence of infection. CONCLUSIONS: Patients with CA stones have a high prevalence of vitamin D deficiency and prescribed vitamin D replacement. Patients with CA stones and evidence of infection tend to have higher proportions of CA on stone analysis, greater rates of hypocitraturia on 24-hour urine collections, and may have lower rates of freedom from subsequent stone treatment compared to patients without evidence of infection. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e206 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nick Dean More articles by this author Jenny Guo More articles by this author Amy Krambeck More articles by this author Expand All Advertisement PDF downloadLoading ...

MP78-02 CRITICALLY EVALUATING THE ROLE FOR POSTOPERATIVE ANTIBIOTICS IN PATIENTS UNDERGOING URETHROPLASTY WITH BUCCAL MUCOSA GRAFT: A CLAIMS DATABASE ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023MP78-02 CRITICALLY EVALUATING THE ROLE FOR POSTOPERATIVE ANTIBIOTICS IN PATIENTS UNDERGOING URETHROPLASTY WITH BUCCAL MUCOSA GRAFT: A CLAIMS DATABASE ANALYSIS Logan Galansky, Andrew Gabrielson, and Andrew Cohen Logan GalanskyLogan Galansky More articles by this author , Andrew GabrielsonAndrew Gabrielson More articles by this author , and Andrew CohenAndrew Cohen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003355.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although many consider administration of antibiotics after urethroplasty dogma, there is lack of evidence regarding the benefit for postoperative antibiotics. We compare perioperative and post-surgical outcomes among patients undergoing first-time urethroplasty with use of buccal mucosa graft (BMG) who receive postoperative antibiotics versus those who do not. METHODS: A retrospective cohort study was conducted using TriNetX research network, a claims database of 110 million patient encounters between 2008-2022. Using applicable CPT, ICD10, and LOINC codes, patients>18 years old undergoing primary urethroplasty with use of BMG, who received perioperative intravenous antibiotics (IVAb), and either received an outpatient prescription for antibiotics between postoperative day 0-30 or did not were queried. Patients with positive pre-operative urine culture or urinary tract infection (UTI) within 30 days prior to urethroplasty were excluded. Surgical outcomes included 5-year revision rates and revision-free survival. Safety outcomes included new UTI within 30 days, surgical site infection (SSI) or clostridium difficile infection within 90 days of the procedure. RESULTS: We identified 645 patients (505 [78%] antibiotic cohort, 140 [22%] no-antibiotic cohort) that met inclusion criteria. There was no difference in mean age at time of urethroplasty, presence of suprapubic tube, or pre-operative rates of common medical comorbidities between cohorts (Table 1). There was no difference in type of IVAb between groups. There was no difference in 5-year rates and revision-free survival for all-cause revision (18.2% vs. 15.7%, log-rank p=0.15), endoscopic revision (10.3% vs. 12.1%, log-rank p=0.94), or surgical revision (11.1% vs. 8.6%, log-rank p=0.17) between groups. Rates of UTI within 30 days, SSI within 90 days, and clostridium difficile infection within 90 days were similar between groups. CONCLUSIONS: In this large retrospective cohort study of patients undergoing urethroplasty with use of BMG, we observed no significant benefit from the use of postoperative antibiotics on revision rates or infectious complications. Limitations of this analysis include inability to delineate between continuous versus short course prophylaxis. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1131 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Logan Galansky More articles by this author Andrew Gabrielson More articles by this author Andrew Cohen More articles by this author Expand All Advertisement PDF downloadLoading ...

MP23-02 USE OF MAYO ADHESIVE PROBABILITY SCORE AS A PREDICTOR OF POSTOPERATIVE FEVER FOLLOWING mPCNL

You have accessJournal of UrologyCME1 Apr 2023MP23-02 USE OF MAYO ADHESIVE PROBABILITY SCORE AS A PREDICTOR OF POSTOPERATIVE FEVER FOLLOWING mPCNL Chia-Min Liu and Chan Jung Liu Chia-Min LiuChia-Min Liu More articles by this author and Chan Jung LiuChan Jung Liu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003248.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Percutaneous nephrolithotomy (PCNL) is the standard treatment for large renal stone. Despite the advanced techniques, postoperative fever and bleeding remain the two major complications but still without effective predictor. Mayo adhesive probability (MAP) score is an image-based renal morphometry scoring system that is used to predict the potential risks and complications of partial nephrectomy but was never evaluated for the association with post-PCNL complications. We aim to explore the predictive value of MAP score on postoperative fever and estimated total blood loss (ETBL) in patients underwent miniaturized PCNL (mPCNL). METHODS: This is a retrospective study recruiting 159 mPCNL patients from July 2018 to January 2022. MAP scores was determined on the basis of pre-operative computed tomography and was calculated algorithmically by posterior renal fat thickness and the extent of perinephric fat stranding. We used Bourke and Smith formula to calculate intraoperative ETBL. Logistic regression analysis was used to determine independent risk factors associated with fever and ETBL. The predictive values of preoperative urine culture combining MAP score for postoperative fever was determined by receiver operating characteristic (ROC) curve analysis. RESULTS: Among 159 study subjects, over half of the patients presented with MAP score ≥ 3 (n=90, 56.6%). Men, elderly, chronic kidney disease, and diabetes mellitus were associated with a higher MAP score. The patients with higher MAP score were more likely to have postoperative fever after mPCNL. On multivariate logistic regression, preoperative positive urine culture (OR 2.44, p=0.01) and a higher MAP score (OR 2.13, p=0.026) were both significantly associated with postoperative fever. ROC curves analysis combining these two factors on predicting postoperative fever showed AUC 0.73 (0.652–0.810) (Figure 1). The posterior perinephric fat thickness was significantly associated with ETBL (β=7.36, p=0.04). CONCLUSIONS: The MAP score was associated with postoperative fever in patients undergoing mPCNL, while posterior perinephric fat demonstrated borderline association with estimated perioperative blood loss volume. The combination of preoperative urine culture and the MAP score can significantly predict the probability of fever in patients receiving mPCNL. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e306 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chia-Min Liu More articles by this author Chan Jung Liu More articles by this author Expand All Advertisement PDF downloadLoading ...

Predictive model for early urosepsis prediction by using systemic inflammatory response syndrome after percutaneous nephrolithotomy

Abstract Objectives The aims of the study are to analyze the potential risk factors associated with systemic inflammatory response syndrome after percutaneous nephrolithotomy for renal stones and to establish a predictive model to prevent postoperative early urosepsis postoperative with percutaneous nephrolithotomy and develop a novel nomogram. Methods Patients who had undergone percutaneous nephrolithotomy between June 2012 and December 2019 were enrolled and classified into two groups according to their systemic inflammatory response status. Univariable and multivariable logistic regression analyses were performed to identify the predictive factors associated with systemic inflammatory response syndrome after percutaneous nephrolithotomy. The nomograms were developed by using the significant factors, and the discriminative ability was assessed using receiver operating characteristic curve analyses. Results Two hundred sixty two patients with renal stones treated with percutaneous nephrolithotomy were enrolled, and systemic inflammatory response syndrome occurred in 117 patients (44%) after percutaneous nephrolithotomy. Multivariable logistic regression analysis revealed that the three factors independently related to systemic inflammatory response syndrome: renal stone size ≥3 cm, positive preoperative urine white blood cells, and positive preoperative urine culture. According to the results, the logistic regression analyses of significant factors were used to develop the nomogram. Developed nomogram prediction model displayed favorable fitting in the Hosmer-Lemeshow test (P = 0.938). Internal validation of the nomogram showed that the area under the receiver operating characteristic curve was 0.702. Conclusions Positive preoperative urine white blood cells, positive urine culture, and renal stone size ≥3 cm are the most significant predictors. The novel nomogram helps identify high-risk individuals and facilitates the early detection of systemic inflammatory response syndrome after percutaneous nephrolithotomy.

Understanding the Role of Ureteral Access Sheath in Preventing Post-Operative Infectious Complications in Stone Patients Treated with Ureteroscopy and Ho:YAG Laser Lithotripsy: Results from a Tertiary Care Referral Center.

The use of ureteral access sheaths (UAS) limits the irrigation-induced increase in intrarenal pressure during ureteroscopy (URS). We investigated the relationship between UAS and rates of postoperative infectious complications in stone patients treated with URS. Data from 369 stone patients treated with URS from September 2016 to December 2021 at a single institution were analyzed. UAS (10/12 Fr) placement was attempted in case of intrarenal surgery. The chi-square test was used to assess the relationship between the use of UAS and fever, sepsis, and septic shock. Univariable and multivariable logistic regression analyses tested the association of patients' characteristics and operative data and the rate of postoperative infectious complications. Full data collection of 451 URS procedures was available. Overall, UAS was used in 220 (48.8%) procedures. As for postoperative infectious sequalae, we recorded fever (n = 52; 11.5%), sepsis (n = 10; 2.2%), and septic shock (n = 6; 1.3%). Of those, UAS was not used in 29 (55.8%), 7 (70%), and 5 (83.3%) cases, respectively (all p > 0.05). At multivariable logistic regression analysis, performing URS without UAS was not associated with the risk of having fever and sepsis, but it increased the risk of septic shock (OR = 14.6; 95% CI = 1.08-197.1). Moreover, age-adjusted CCI score (for fever-OR = 1.23; 95% CI = 1.07-1.42, sepsis-OR = 1.47; 95% CI = 1.09-1.99, and septic shock-OR = 1.61; 95% CI = 1.08-2.42, respectively), history of fever secondary to stones (for fever-OR = 2.23; 95% CI = 1.02-4.90) and preoperative positive urine culture (for sepsis-OR = 4.87; 95% CI = 1.12-21.25) did emerge as further associated risk factors. The use of UAS emerged to prevent the onset of septic shock in patients treated with URS, with no clear benefit in terms of fever and sepsis. Further studies may help clarify whether the reduction in fluid reabsorption load mediated by UAS is protective against life-threatening conditions in case of infectious complications. The patients' baseline characteristics remain the main predictors of infectious sequelae in a clinical setting.