Positive Preoperative Urine Culture Research Articles

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.

Postoperative outcomes in surgical patients at high risk of urosepsis related to persistence of positive preoperative urine culture before and after the adoption of a tailored Multidisciplinary Team protocol: A comparative study

Postoperative outcomes in surgical patients at high risk of urosepsis related to persistence of positive preoperative urine culture before and after the adoption of a tailored Multidisciplinary Team protocol: A comparative study

Can we identify the risk factors for SIRS/sepsis after percutaneous nephrolithotomy? A meta‑analysis and literature review.

With the increase in percutaneous interventions such as percutaneous nephrolithotomy (PCNL) for renal lithiasis, infectious complications are becoming more frequent. The present study performed a systematic Medline and Embase databases search, using the following words: 'PCNL' [MeSH Terms] AND ['sepsis' (All Fields) OR 'PCNL' (All Fields)] AND ['septic shock' (All Fields)] AND ['urosepsis' (MeSH Terms) OR 'Systemic inflammatory response syndrome (SIRS)' (All Fields)]. Because of the technological advances in endourology, articles published between 2012 and 2022 were searched. Of the 1,403 results of the search, only 18 articles, representing 7,507 patients in which PCNL was performed, met the criteria to be included in the analysis. All authors applied antibiotic prophylaxis to all patients and, in some cases, the infection was treated preoperatively in those with positive urine cultures. According to the analysis of the present study, the operative time has been significantly longer in patients who developed SIRS/sepsis post-operatively (P=0.0001) with the highest heterogeneity (I2=91%) compared with other factors. Patients with a positive preoperative urine culture had a significantly higher risk of developing SIRS/sepsis following PCNL (P=0.00001), OD=2.92 (1.82, 4.68) and there was also a high degree of heterogeneity (I2=80%). Performing a multi-tract PCNL also increased the incidence of postoperative SIRS/sepsis (P=0.00001), OD=2.64 (1.78, 3.93) and the heterogeneity was a little smaller (I2=67%). Diabetes mellitus (P=0.004), OD=1.50 (1.14, 1.98), I2=27% and preoperative pyuria (P=0.002), OD=1.75 (1.23, 2.49), I2=20%, were other factors that significantly influenced postoperative evolution. A total of two factors analyzed, body mass index and patient's age, did not influence the outcome, P=0.45, I2=58% and P=0.98, I2=63%.

The Relationship between Preoperative Urine Culture and Post-Percutaneous Nephrostolithotomy Systemic Inflammatory Response Syndrome: A Single-Center Retrospective Study.

To predict the occurrence of systemic inflammatory response syndrome (SIRS) after percutaneous nephrostrolithotomy(PCNL), preoperative urine culture is a popular method, but the debate about its predictive value is ongoing. In order to better evaluate the value of urine culture before percutaneous nephrolithotomy, we conducted a single-center retrospective study. A total of 273 patients who received PCNL in Shanghai Tenth People's Hospital from January 2018 to December 2020 were retrospectively evaluated. Urine culture results, bacterial profiles, and other clinical information were collected. The primary outcome observed was the occurrence of SIRS after PCNL. Univariate and multivariate logistic regression analysis was performed to determine the predictive factors of SIRS after PCNL. A nomogram was constructed using the predictive factors, and the receiver operating characteristic (ROC) curves and calibration plot were drawn. Our results showed that there was a significant correlation between positive preoperative urine cultures and the occurrence of postoperative systemic inflammatory response syndrome. Meanwhile, diabetes, staghorn calculi, and operation time were also risk factors for postoperative systemic inflammatory response syndrome. Our results suggest that among the positive bacteria in urine culture before percutaneous nephrolithotomy, Enterococcus faecalis has become the dominant strain. Urine culture is still an important method of preoperative evaluation. A comprehensive evaluation of multiple risk factors should be undertaken and heeded to before percutaneous nephrostrolithotomy. In addition, the impact of changes in bacterial drug resistance is also worthy of attention.

Hypoalbuminemia Within One Hour After Surgery as a Predictor of Post-Operative Urosepsis in Patients Undergoing Flexible Ureteroscopy Lithotripsy: A Retrospective Study.

Abstract Background: To investigate retrospectively whether changes in serum albumin levels within one hour of flexible ureteroscopy (fURS) lithotripsy can be used as a predictor of post-operative urosepsis. Patients and Methods: Eligible patients with unilateral upper urinary calculi who underwent fRUS lithotripsy performed by a single surgeon at our center were included in the analysis. The patients were divided into sepsis and non-sepsis groups. The change ratio of albumin and white blood cell (WBC) count was calculated by post-operative/pre-operative index*100%. Univariable and multivariable logistic regression analyses were used to assess whether there was a correlation between risk factors and post-operative urosepsis. The receiver operating characteristic (ROC) curve was used to analyze factors that showed significant differences in multivariable logistic regression analysis. Results: A total of 314 patients were included in the analysis, 20 of whom had post-operative urosepsis and five developed septic shock; no deaths occurred. Multivariable logistic regression analysis showed that urine culture results, WBC counts within one hour after surgery, post-operative albumin levels, and the degree of albumin changes after surgery were independent predictors of post-operative urosepsis. Receiver operating characteristic curve analysis showed that noteworthy hypoalbuminemia after surgery and positive pre-operative urine culture could help screen high-risk patients for post-operative urosepsis effectively. Conclusions: Hypoalbuminemia shortly after operation can be utilized as a predictor for early diagnosis of post-operative urosepsis in patients undergoing fURS lithotripsy.

Postoperative pain factors after ureterscopic removal of stones in kidney and ureter Authors

Objective: Postoperative wpain after ureteroscopic removal of ureter and kidney stones frequently leads to re-hospitalization, revisit and increased cost. However, risk factors and incidence for early postoperative pain are still unclear. The aim of this study is to investigate the associated risk factors and the incidence of acute postoperative pain after ureteroscopic stone removal in the ureter and kidney. Materials and Methods: Retrospective data from 306 consecutive patients who underwent ureteroscopic treatment for ureteral and kidney stones from January 2016 to December 2020 were collected. The patients were divided into two groups: (i) Mild postoperative pain (n = 179), defined as a pain score lower than four on the visual analog pain scale during the first operative day, and (ii) Moderate to severe postoperative pain (n = 127) was defined as a pain score of greater than or equal to 4 during the first operative day. Potential risk factors were included in the univariable and multivariable regression analyses to identify risk factors for developing moderate to severe pain. Results: 127 (41.5%) patients experienced moderate to severe postoperative pain on the first postoperative day. From multivariable analysis, positive pre-operative urine culture, operative time of more than 60 minutes, a stone procedure in the ureter, a postoperative stent, and ureter injury greater than grade I were related to moderate to severe pain with significance risk ratios (RR) of 2.99, 3.70, 4.87, 3.30, and 2.96, respectively (p < 0.05). Conclusion: Pain is a frequent postoperative problem associated with ureterscopic removal of stones and should be pro-actively treated with care. Patients are at a higher risk of moderate to severe pain if they required the ureteral procedure, had prolonged operative time, ureter injury after the procedure, needed a stent postoperatively, or had a history of positive preoperative urine culture.

Real Time Intrarenal Pressure Control during Flexible Ureterorrenscopy Using a Vascular PressureWire: Pilot Study.

(1) Introduction: To evaluate the feasibility of measuring the intrapelvic pressure (IPP) during flexible ureterorenoscopy (f-URS) with a PressureWire and to optimize safety by assessing IPP during surgery. (2) Methods: Patients undergoing f-URS for different treatments were recruited. A PressureWire (0.014", St. Jude Medical, Little Canada, MN, USA) was placed into the renal cavities to measure IPP. Gravity irrigation at 40 cmH2O over the patient and a hand-assisted irrigation system were used. Pressures were monitored in real time and recorded for analysis. Fluid balance and postoperative urinary tract infection (UTI) were documented. (3) Results: Twenty patients undergoing f-URS were included with successful IPP monitoring. The median baseline IPP was 13.6 (6.8-47.6) cmH2O. After the placement of the UAS, the median IPP was 17 (8-44.6) cmH2O. With irrigation pressure set at 40 cmH2O without forced irrigation, the median IPP was 34 (19-81.6) cmH2O. Median IPP during laser lithotripsy, with and without the use of on-demand forced irrigation, was 61.2 (27.2-149.5) cmH2O. The maximum pressure peaks recorded during forced irrigation ranged from 54.4 to 236.6 cmH2O. After the surgery, 3 patients (15%) presented UTI; 2 of them had a positive preoperative urine culture, previously treated, and a positive fluid balance observed after the surgery. (4) Conclusion: Based on our experience, continuous monitoring of IPP with a wire is easy to reproduce, effective, and safe. In addition, it allows us to identify and avoid high IPPs, which may affect surgery-related complications.

SEPSIS IN POST-PCNL PATIENTS; RISK FACTORS AND INFLUENCE OF STONE CULTURES.

Objective: Post-operative sepsis is a well known complication of various endourologic procedures especially PCNL and it is caused by stone fragmentation containing toxins and bacteria with subsequent toxaemia and bacteremia. The present study was to determine clinical role of stone culture in modifying treatment and assess the factors that may increase the risk to develop sepsis after PCNL . Methods: A total of 211 patients (119 males and 92 females) with a mean age of 38.2 years were enrolled in this study at our single centre tertiary care institute . Patients with preoperative positive urine culture and sensitivity were excluded . All patients received prophylactic 3rd generation cephalosporin intravenously at the time of anaesthesia induction. Stone culture was taken from all patients after puncturing the pelvicalyceal system and sent for culture and sensitivity. Patients were monitored closely in the postoperative period for the development of SIRS. Risk factors such as diabetes, age, degree of hydronephrosis, residual fragments, number of access points PCNL type (standard versus mini) and stone burden were evaluated for the association with SIRS. Results: Mean duration of the operations was 82.7 min (30 to 110 min. ). 19 patients(9.0 %) developed post PCNL SIRS Stone culture identied organisms in8 patients(42% of patient cohort ). Treatment plan was changed as per antibiotic culture sensitivity in only one patientwith culture sensitivity report in three patients being multi drug resistant and rest responded to antibiotics they were receiving already. Statistically signicant factors for post PCNL fever were diabetes mellitus (DM) (p = 0.001), stone burden (p = 0.004), and degree of hydronephrosis (p = 0.04). Conclusion: Doing intraoperative stone cultures sensitivity does not confer additional benet for antibiotic change in majority of cases.DM, staghorn stones, degree of hydronephrosis, duration of the operation and number of tracts are risk factors for post PCNL SIRS.

Comparative Study between Initial Positive and Negative Preoperative Urine Culture for Postoperative Fever in PCNL Patients

Background: The exact mechanism of fever after PCNL has not been established.2. This research studied the frequency of post-PCNL fever and UTI in both initial preoperative positive and negative urine culture group of patients. Objectives: To compare the frequency of post PCNL fever and UTI in initial positive and negative preoperative urine culture patients. Method: This was a prospective observational study on a total sixty patients who underwent single PCNL at the Department of Urology, Sir Salimullah Medical College Mitford Hospital, Dhaka and National Institute of Kidney Diseases and Urology, Dhaka from March 2013 to October 2014.There were two groups of patients, Group-I, with initial positive preoperative urine culture and another Group-II with initial negative preoperative urine culture. But the operation deferred until the positive urine culture became negative. Both groups received prophylactic antibiotic. Results: The frequency of fever and UTI after PCNL was 53.33% in Group-I (n=30) but only 23.33% was found in Group-II (n=30).Significant correlations were observed between post-PCNL fever with initial positive preoperative urine culture group (p=0.017), female sex (p=0.02), prolong hospital stay (p=0.018). Conclusion: The frequency of postoperative fever and UTI is more than two times in preoperative positive urine culture patients than culture negative patients. Risk of post- PCNL fever increased in patients who had initial positive preoperative urine culture. Bangladesh J. Urol. 2021; 24(1): 25-32

Predicting urine culture results in candidates for lithotripsy.

Urological guidelines assert that "urine culture should be obtained" before surgical management of ureteral or kidney stones. Thus, many surgeries are delayed by 1-3 days until the results of urine culture are available. During this time, the patient frequently experience pain and possible kidney damage. We investigated the hypothesis that it is possible to predict the results of urine culture in candidates for surgical intervention using parameters that are accessible immediately upon admission. A database of 1000 patients who underwent either percutaneous nephrolithotomy (PCNL) or ureteroscopy/retrograde intrarenal surgery was analyzed. Eleven parameters potentially related to urinary infections and accessible to the clinician at the emergency department were correlated with the preoperative urine culture results. Of the patients, 234 (23.4 %) had positive cultures. On multivariate analysis, only sex, hydronephrosis grade, and history of previous nephrolithotomy were significantly associated with a positive preoperative urine culture. The risk of a positive culture can be easily determined from a simple table or an Excel-based calculator. This risk could be as low as 0.45% for a man without a history of PCNL and no hydronephrosis (4% in a woman with similar parameters) or as high as 79.5% in a man with a history of PCNL and hydronephrosis (85% in a woman with similar parameters). The risk of preoperative positive urine culture can be predicted using 3 parameters that are accessible upon admission. In low-risk cases, prompt surgical treatment can be provided, eliminating the anticipation time for urine culture results.

Efficacy of Flexible Ureteroscopic Lithotripsy and Percutaneous Nephrolithotomy in the Treatment of Complex Upper Urinary Tract Nephrolithiasis.

Objective A case-control study was conducted to compare the efficacy and prognostic factors of flexible ureteroscopic lithotripsy (FURL) and percutaneous nephrolithotomy (PCNL) when treating complex upper urinary tract renal calculi based on a retrospective cohort study. Methods The study period was from October 2019 to December 2021. A retrospective study was carried out on 100 patients with complicated upper urinary tract nephrolithiasis who underwent surgery in the Urology Department of our hospital. They were assigned into two groups: FURL and PCNL groups. The intraoperative blood loss, operation time, hematuria duration, hospital stay, primary stone removal rate, incidence of intraoperative and postoperative complications, VAS score, level of inflammatory factors, and micturition function were compared. According to the postoperative prognosis, the patients were reassigned into two groups: good prognosis group (n = 38) and poor prognosis group (n = 106). The factors related to poor prognosis after FURL and PCNL were screened, and multivariate loglistic regression analysis was adopted to determine the risk factors. Results The primary stone clearance rate in the PCNL group was significantly higher than that in the FURL group, and there was no significant difference in the incidence of intraoperative and postoperative complications between the two groups (P > 0.05). The intraoperative blood loss and the duration of hematuria in the PCNL group were significantly shorter than those in the FURL group, and the operation time and postoperative hospital stay in the FURL group were longer than those in the FURL group. The postoperative VAS score in the study group was significantly lower than that in the control group (P < 0.05). The levels of CRP, IL-1, TNF-α, and NF-κB in both groups decreased after operation, and the level of inflammatory factors in the PCNL group was significantly lower than that in the FURL group (P < 0.05). The indexes of IPSS and Qmax in the PCNL group were significantly lower than those in the control group 3 months after operation. The index of micturition function in the PCNL group was significantly lower than that in the FURL group. Preoperative use of immunosuppressant, preoperative stone fever, positive preoperative urine culture, preoperative urinary leukocyte count ≥ 544 × L, intraoperative urinary opacity, and pus fur were significantly correlated with poor prognosis of ureteral patients (P < 0.05). Preoperative stone fever, high preoperative urinary leukocyte count, intraoperative urinary turbidity, and suppurative fur were independent risk factors for postoperative SIRS in patients with ureteral calculi. Conclusion PCNL is effective when treating complex upper urinary tract renal calculi. Compared with FURL, PCNL can remarkably reduce intraoperative blood loss and hematuria duration, can enhance micturition function, and will not remarkably increase the incidence of intraoperative and postoperative complications, high safety. High white blood cell count in urine before operation, fever due to stone before operation, turbid urine, and purulent fur during operation are independent risk factors for postoperative adverse outcome in patients with complex upper urinary tract renal calculi. Patients should be fully treated before surgery.

Infección de vías urinarias después de resección transuretral de vejiga: Microbiología, resistencia antibiótica y factores de riesgo asociados.

Objective: Investigate the microbiology and incidence of drug resistance in patients undergoing TURBT and to identify independent risk factors for UTI following surgery.&#x0D; Material &amp; Methods : Retrospective observational study of prospectively collected data of 199 patients who underwent TURBT in a tertiary care center in Mexico City between 2017-2019. Baseline characteristics and microbiological data (frequency of isolated bacteria and antibiotic resistance pattern) were analyzed according to the presence of UTI following surgery. Binary logistic regression analysis was performed to identify independent risk factors for UTI.&#x0D; Results: A preoperative positive urine culture (PUC) was present in 28 patients (14%), the most common isolated pathogens were Escherichia coli(48%), Enterococcus faecalis(24%) and Proteus mirabilis(7%). UTI was documented in 20 patients after TURBT (10%), being E. coli(45%) the most common uropathogen which was resistant to Trimethoprim/Sulfamethoxazole(60%) and Ciprofloxacin(40%). Other common isolated pathogens were E. faecalis(27%) and P. mirabilis(9%). There was significant difference in the presence of a PUC before TURBT and necrosis (p=0.001). On the multivariate analysis the PUC before TURBT was associated with UTI after TURBT (OR7.04 [95%CI 2.11-23.29]).&#x0D; Limitations: Retrospective study with information limited to the clinical file.&#x0D; Originality: There is little information about UTI after TURBT in global literature, in Mexico there is no information, being this study unique in his kind.&#x0D; Conclusions: The incidence of UTI after TURBT was 10%. The strongest associated risk factor for UTI after TURBT was a preoperative PUC. The most common isolated uropathogen was E. coli. Trimethoprim/Sulfamethoxazole(60%) and Ciprofloxacin(40%) were the most resistant antibiotics for E. coli.

MP02-20 DECREASED RISK OF URINARY INFECTION IS ASSOCIATED WITH SINGLE USE URETEROSCOPES

You have accessJournal of UrologyCME1 May 2022MP02-20 DECREASED RISK OF URINARY INFECTION IS ASSOCIATED WITH SINGLE USE URETEROSCOPES Rei Unno, Xavier Cortez, Leslie Charondo, Kevin Chang, Nizar Hakam, Carter Chan, Heiko Yang, Gregory Hosier, Fadl Hamouche, David Bayne, Marshall Stoller, and Thomas Chi Rei UnnoRei Unno More articles by this author , Xavier CortezXavier Cortez More articles by this author , Leslie CharondoLeslie Charondo More articles by this author , Kevin ChangKevin Chang More articles by this author , Nizar HakamNizar Hakam More articles by this author , Carter ChanCarter Chan More articles by this author , Heiko YangHeiko Yang More articles by this author , Gregory HosierGregory Hosier More articles by this author , Fadl HamoucheFadl Hamouche More articles by this author , David BayneDavid Bayne More articles by this author , Marshall StollerMarshall Stoller More articles by this author , and Thomas ChiThomas Chi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002514.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although single-use ureteroscopes have been shown to be comparable with reusable ureteroscopes in terms of intraoperative maneuverability, visual image quality, as well as stone-related clinical outcomes, there are few large scale reports regarding clinical outcomes related to single-use ureteroscopes. In the current study, we aimed to understand the impact of single-use ureteroscopes on clinical outcomes for ureteroscopic stone removal and whether their use reduced postoperative urinary tract infection (UTI) risk. METHODS: This was a single-center, retrospective cohort study designed to compare single-use with reusable flexible ureteroscopes regarding peri- and postoperative outcomes between June 2012 and March 2021. The primary endpoint was postoperative UTI. The secondary endpoints were intraoperative outcomes (operative time and stone clearance), perioperative complications, hospitalization time, and re-presentation to the hospital (telephone call, ED visit, and re-admission) after URS. RESULTS: A total of 991 patients were analyzed, 500 patients in the single-use URS group (50.4%) and 491 patients in the reusable group (49.6%). On univariate analysis, patients in the single-use URS group were more often male and had lower BMI and presented with more bilateral stones than those in the reusable group. Single-use URS was associated with a lower chance of postoperative UTI (6.5% vs 11.9%, p=0.018) as well as a higher stone clearance rate (90.0% vs 83.9%, p=0.005) and fewer postoperative telephone calls (19.2% vs 29.2%, p=0.002). There were no significant differences in operative time, perioperative complications, ED visits, and re-admission between the two groups. On multivariate analysis, single-use URS remained a strong factor associated with stone clearance rate and decreased risk of postoperative UTI and postoperative telephone calls (Table 1). Postoperative sepsis, perioperative complications, and re-admission were associated with a positive preoperative urine culture. CONCLUSIONS: These data show that the single-use URS is beneficial in reducing postoperative UTI and telephone calls as well as increasing the stone clearance rate. These results provide a clinical justification for their routine use during ureteroscopic stone removal. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e18 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rei Unno More articles by this author Xavier Cortez More articles by this author Leslie Charondo More articles by this author Kevin Chang More articles by this author Nizar Hakam More articles by this author Carter Chan More articles by this author Heiko Yang More articles by this author Gregory Hosier More articles by this author Fadl Hamouche More articles by this author David Bayne More articles by this author Marshall Stoller More articles by this author Thomas Chi More articles by this author Expand All Advertisement PDF DownloadLoading ...

Proactive discontinuation of postoperative antibiotic prophylaxis after urethroplasty.

We aimed to examine the clinical significance of an antimicrobial administration protocol, in which postoperative prophylaxis was proactively discontinued. We included 81 adult urethroplasties performed at our institution in the study. Preoperative bacteriuria was treated using an appropriate antimicrobial agent 2-5 days before surgery. All patients were treated with intravenous antimicrobial agents until postoperative day 2, and thereafter without prophylaxis. Antibiotics were resumed from the day before the urethrogram for urethral catheter removal, 2-3 weeks postoperatively. The relationships between pre- and postoperative positive urine culture and postoperative infectious complications, along with factors influencing surgical success rate were examined retrospectively. Of the 81 patients, 60 underwent anastomotic repair and 21 underwent substitution repair. Positive preoperative urine cultures were more frequent in patients having suprapubic cystostomy tube than in those without (P < 0.0001), but such a difference was not noted postoperatively between the two groups, and approximately half of the patients had a positive urine culture postoperatively. Wound infections and symptomatic urinary tract infections rates were 3.7% and 2.5%, respectively, similar to previous studies with longer prophylaxis, and no significant correlation was noted with pre- and postoperative positive urine culture, treated by this antibiotic protocol. The overall clinical and objective success rates were 96.3% and 79.0%, respectively, and no significant impact of pre- or postoperative positive urine culture was noted. The only significant parameter for objective success was patient age. Perioperative management of urethroplasty is feasible using the antimicrobial protocol described in this study.

The effect of preoperative urine culture and bacterial species on infection after percutaneous nephrolithotomy for patients with upper urinary tract stones

To study the relationship between preoperative urine culture, bacterial species and infection after percutaneous nephrolithotomy in patients with upper urinary tract stones, and summarize the clinical characteristics of different bacterial infections. From January 2014 and January 2020, 963 patients with upper urinary tract stones who underwent PCNL in the department of urology of Fujian provincial hospital were included in the study. Information included the patient’s age, gender, weight, diabetes, chronic disease history, urine routine, preoperative urine culture results, stone size, number of stones, hydronephrosis level, operation time, body temperature, heart rate, blood pressure, breathing rate, hemoglobin, serum creatinine, bilirubin, platelets and whether there was preoperative infection were recorded. 141 patients (14.6%) had a positive urine culture before surgery, and 7 of them had multiple bacterial infections. The most common pathogenic bacteria was Escherichia coli, followed by Enterococcus and Klebsiella pneumoniae. A total of 74 cases (7.7%) of 963 patients with infection after PCNL occurred, 24 cases (32.4%) of infected patients progressed to urinary septic shock. Univariate analysis shown that the probability of infection in patients with long operation time and positive urine culture was significantly higher, and the difference was statistically significant. Further multivariate logistic regression analysis shown that positive urine culture before operation and long operation time were independent risk factors for infection after PCNL. Among the 29 patients with septic shock, 18 cases (62.1%) had a positive urine culture before surgery. The incidence (43.9%) of postoperative infection in Escherichia coli positive patients was significantly higher than that in the negative group, and the difference was statistically significant. The rate of patients with Escherichia coli infection progressing to septic shock was 9 cases (60%). 2 patients with Enterococcus faecium infection and 2 patients with Klebsiella pneumoniae infection all progressed to septic shock. The age of patients with post-PCNL infection caused by Escherichia Coli, Enterococcus faecium and Klebsiella pneumoniae were 58.53 ± 11.73 years, 76.5 years and 74 years.The body temperature of patients with post-PCNL infection caused by Escherichia Coli, Enterococcus faecium and Klebsiella pneumoniae were 39.10 ± 0.25 °C, 39.45 °C and 38.65 °C. The highest pct value of patients with post-PCNL infection caused by Escherichia Coli, Enterococcus faecium and Klebsiella pneumoniae were 80.62 ± 31.45 ng/mL, 24.32 ng/mL and 8.45 ng/mL. The nitrite positive rate of patients with post-PCNL infection caused by Escherichia Coli, Enterococcus faecium and Klebsiella pneumoniae were 64.51%, 16.6% and 0. Postoperative infection of PCNL is significantly correlated with positive preoperative urine culture, and positive preoperative urine culture is an independent risk factor for postoperative infection. The most common pathogen of postoperative infection of PCNL is Escherichia coli, followed by Enterococcus and Klebsiella pneumoniae. Patients with Escherichia coli infection are often positive for nitrite before surgery, mainly manifested by high fever, and PCT is significantly increased (often exceeded 100 ng/ml). Enterococcus faecium and Klebsiella pneumoniae infections mostly occur in elderly patients and often progress to septic shock. Patients with Enterococcus faecium infection have a high fever, and the PCT value is significantly higher (often exceeded 20 ng/ml). Patients with Klebsiella pneumoniae infection have a moderate fever, and the PCT value generally does not exceeded 10 ng/ml. Long operation time is another independent risk factor for PCNL infection.

Nomograms for Predicting the Risk of SIRS and Urosepsis after Uroscopic Minimally Invasive Lithotripsy.

Objective To analyze the potential risk factors that affect the development of urosepsis following uroscopic minimally invasive lithotripsy and to develop a nomogram that predicts the probability of postoperative urosepsis. Methods We retrospectively analyzed the clinical data from patients that underwent percutaneous nephrolithotripsy (PCNL) or ureteroscopic lithotripsy (URL) between January 2018 and December 2019. The enrolled patients were grouped twice according to systemic inflammatory response syndrome (SIRS) and quick sequential organ failure assessment (qSOFA). After univariate and multivariate logistic regression analyses, we identified the independent predictive factors affecting the development of postoperative SIRS and urosepsis, and built the nomograms. Results From January 2018 to December 2019, 1959 patients underwent PCNL or URL, of whom 236 patients were accorded with the inclusion criteria. Of all 236 patients, 64 (27.12%) patients developed postoperative SIRS, and 17 (7.20%) patients developed postoperative urosepsis. Multivariate logistic regression analysis showed that positive preoperative urine culture (PUC+) (OR = 2.331, P = 0.044), procalcitonin (PCT) (OR = 1.093, P = 0.037), C-reactive protein (CRP) (OR = 1.017, P < 0.001), and neutrophil ratio (NEUT%) (OR = 1.091, P = 0.004) of postoperative were independent predictors of SIRS, and PCT (OR = 1.017, P = 0.003) and CRP (OR = 1.080, P < 0.001) were independent predictors of urosepsis. Additionally, the nomograms demonstrated good accuracy in predicting SIRS and urosepsis with a C-index of 0.884 (95% CI: 0.835-0.934) and 0.941 (95% CI: 0.885-0.996), respectively. Conclusions The nomograms achieved the prediction of SIRS and urosepsis after uroscopic minimally invasive lithotripsy. Using this model, the risk of SIRS or urosepsis for an individual patient can be determined, which facilitates early diagnosis and rational treatment.

Can We Identify Patients in Danger of Complications in Retrograde Intrarenal Surgery?-A Retrospective Risk Factors Analysis.

Retrograde intrarenal surgery (RIRS) is an innovative and effective method of kidney stones treatment, as it had great influence on the development of endoscopy in urology. The increasing prevalence of urolithiasis together with the rapid development of endourology leads to a rise in the number of procedures related to the disease. Flexible ureteroscopy is constantly being improved, especially regarding the effectiveness and safety of the procedure. The purpose of this study is to evaluate intraoperative and early post-operative complications of RIRS in the treatment of kidney stones. A retrospective analysis of medical records was performed. A series was comprised of 207 consecutive operations performed from 2017 to 2020. Complications occurred in 19.3% (n = 40) of patients. Occurrence according to the Clavien-Dindo scale was: 11.1% for grade I, 5.8% for grade II and 2.4% for grade IV. Infectious complications included SIRS (5.3%, n = 11) and sepsis (2.4%, n = 5). Statistical analysis revealed a correlation between acute post-operative infections and positive midstream urine culture, history of chronic or recurrent urinary tract infections, and increased body mass index (BMI). Furthermore, a significant correlation was observed between pain requiring the use of opioids with BMI over 25. Consequently, history of urinary tract infections, positive pre-operative urine culture, and increased BMI are considered risk factors and require appropriate management.

Experiences in managing different consequences of forgotten ureteral stents.

PurposeWe reported the different consequences of forgotten stents and share our managing experiences.Patients and MethodsFrom July 2011 to August 2019, eight patients (five men and three women) with forgotten encrusted ureteral stents were treated by different endoscopic procedures in our center. Plain-film radiography (kidney, ureter, and bladder [KUB]) and computed tomography were used to evaluate the position of stents, the site of encrustation, and the stone burden. Various sole or combined endoscopic techniques including percutaneous nephrolithotomy, retrograde ureteroscopic lithotripsy, and cystolitholapaxy were used to achieve stent removal.Results:The average age of the patients was 50.9 years (range: 25–72 years). The mean indwelling time of the stents was 32.9 months (range: 12–83 months). Mean stent stone burden was 15 mm × 10 mm. Three patients had stent stone burden larger than 20 mm. Three patients had a preoperative positive urine culture before treatment. The stent was fragmented in two patients. The ureteral stents and related stones were successfully removed without any complications by a sole or combined endoscopic techniques with stone-free status achieved in all patients. There is no complications occurred.Conclusion:Forgotten stents can lead to complicated urinary tract calculi, stent encrustation, urinary tract infection, vesicoureteric reflux, and even ureteral polyps. Various sole or combined endourological techniques can be used to manage the forgotten encrusted ureteral stents.

The value of procalcitonin for predicting urosepsis after mini-percutaneous nephrolithotomy or flexible ureteroscopy based on different organisms.

To assess the value of procalcitonin (PCT) as an early biomarker for predicting urosepsis caused by Gram-negative (GN) bacteria, Gram-positive (GP) bacteria and fungi following mini-percutaneous nephrolithotomy (mPCNL) and flexible ureteroscopy (FURS). A total number of 356 patients with positive preoperative UC (urine cultures) who underwent mPCNL and FURS between June 2017 and January 2021 were retrospectively analyzed. Univariable analysis and multivariable logistic regression analysis were conducted to compare the predictors for urosepsis caused by different organisms. Furthermore, the nomogram was established as a predicted model for urosepsis. Among 356 positive UC, 265 (74.4%) were positive for GN bacteria, 77 (21.4%) for GP bacteria and 14 (3.9%) for fungal pathogens. Escherichia coli (48.9%) were the predominant pathogens and Enterococcus (54/77) were the most common GP bacteria. Multivariate logistic regression analysis showed that positive nitrite (OR 3.31, 95% CI 1.20-9.14; P = 0.021), operative time > 90min (OR 3.10, 95% CI 1.10-8.75, P = 0.033) and postoperative PCT > 0.1ng/mL (OR 56.18, 95% CI 15.20-207.64, P < 0.001) were associated with postoperative urosepsis originated in GN infections, while urosepsis caused by GP bacteria and fungi was not associated with PCT > 0.1ng/mL (P = 0.198), only stone burden > 800mm2 (OR 3.69, 95% CI 1.01-13.53, P = 0.049) was an independent risk factor. For patients with positive preoperative UC, postoperative PCT > 0.1ng/mL was an independent risk factor of post-PCNL and post-FURS urosepsis caused by GN bacteria rather than GP bacteria and fungi.