Positive Preoperative Urine Research Articles

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.

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 ...

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 ...

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 ...

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 ...

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.

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

The influence of indwelling double-J stent duration prior to URS on postoperative complicated urinary tract infections

AbstractUreterorenoscopy and double‑J stents are frequently associated with complicated urinary tract infections (cUTI’s). To date, it remains unclear whether longer indwelling stent duration increases the risk of cUTI’s and recommendations on this subject are therefore lacking. This study investigates whether double‑J stent placement and longer indwelling stent duration prior to URS increase the risk of post-URS cUTI’s. Adult patients undergoing ureterorenoscopy in 2019 were eligible for study participation. Records were retrospectively collected. Potential risk factors were evaluated using multivariate logistic regression models. 16.9% of the prestented patients was diagnosed with a UTI, compared to 7.1% in the non-prestented group (p = 0.034). Female gender, preoperative positive urine cultures and stone recurrence were significant risk factors. This study demonstrated a correlation between preoperative placement of double‑J stents and post-URS complicated UTI’s. However, neither preoperative double‑J stent placement nor longer indwelling stent time was a significant risk factor for postoperative complicated UTI’s.

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 &lt; 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.

Is Preoperative Urine Human Chorionic Gonadotropin (hCG) Testing Necessary for Pediatric Patients Before Oral and Maxillofacial Surgery Procedures With Sedation?

Human chorionic gonadotropin (hCG) testing is performed prior to surgical procedures to ensure patient and fetal safety. The purpose of this study was to evaluate the utility of routine pregnancy testing prior to elective outpatient oral and maxillofacial surgery procedures being performed with intravenous sedation (IVS). A retrospective cohort study was implemented assessing hCG testing in postmenarche females who underwent elective outpatient oral surgery procedures scheduled with IVS at a tertiary care institution. Medical records were used to identify eligible subjects aged 12 to 45years. The primary predictor variable was age, and the primary outcome variable was urine hCG test result. Age was divided into groups to reflect early adolescence (12 to 14years), mid-adolescence (15 to 17years), late adolescence/early adulthood (18 to 24years) and adulthood (25+ years). Secondary outcome variables included inability to void for hCG testing, change in anesthetic, case cancellation or rescheduling and were measured over a 2year period. Descriptive statistics were performed. Relative risk (RR) and Cochran-Armitage test for trend were calculated to determine the statistical significance of age on inability to void. The sample consisted of 5,006 females, with a median age (IQR, range) of 18.0 (3.6, 12.0 to 43.6) years. There was one positive urine hCG result providing a preoperative pregnancy rate of 0.02%. Fourteen of 1,195 subjects (1.2%) over a 2year period were unable to provide a urine hCG sample. There was a statistically significant trend in inability to void as age groups got older (P=.001). Patients aged 12 to 17years had an increased risk of being unable to void compared to patients 18years and older (RR: 14.30, 95% CI: 1.88 to 108.99, P=.01). The total cost of testing over the 11year observation period was $9,019.59. The risk of surgical cancellations and delayed care due to patients' inability to void preoperatively plus a lack of any positive preoperative urine hCG findings in patients under 18years of age in this study, call into question the necessity of routine preoperative hCG screening in pediatric patients presenting for IVS for elective outpatient oral and maxillofacial procedures.

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.