Postoperative Urinary Infection Research Articles

Reconstruction of Urethral Sphincter With Polyacrylamide Hydrogel.

Urethral bulking is an alternative to synthetic midurethral sling for the treatment of stress urinary incontinence (SUI) in women. Urethral bulking agents, which are injected in the submucosal tissues of the proximal urethra/bladder neck, have demonstrated less adverse effects with similar satisfaction rates but lower subjective and objective cure rates when compared with midurethral sling. Cystoscopic Reconstruction of External Sphincter Technique (CREST) is a novel technique, which reinforces the natural closure mechanism of the external urinary sphincter (EUS). The aim of the study was to provide safety and efficacy data for injecting polyacrylamide hydrogel (PAHG) in the components of the female EUS. This was a retrospective chart review of patients using CREST with PAHG as initial treatment for SUI by a single surgeon from January 2022 to October 2022. Exclusion criteria are as follows: younger than 18 years, prior SUI surgery, concomitant pelvic organ prolapse or reconstructive procedure, neurological conditions, or history of radiation. Subjective and objective cure rates were measured by patient-reported symptoms and cough stress test. Urinary retention, postoperative urinary infection, and de novo urinary urgency were assessed. One hundred and thirteen consecutive patients met inclusion criteria with median follow-up of 3 months. Eighty-five percent of participants reported subjective improvement, 69% reported subjective cure, and 69% demonstrated objective cure. Nine patients reported transient postoperative retention, 8 reported postoperative urinary tract infections, and 5 reported de novo urgency. There were no serious adverse events. CREST is a novel technique for injection of PAHG, into the EUS to treat SUI. Our data suggest that this technique could improve urethral injection outcomes with minimal complications.

The Effectiveness of Deflux® Treatment for Vesicoureteral Reflux Following Pediatric Renal Transplantation: A Single-Institution Challenging Experience

PurposeTo validate the effectiveness of Deflux® treatment for vesicoureteral reflux (VUR) following pediatric renal transplantation (RT), based on our single-institution experience. MethodA retrospective study was conducted using the medical records of pediatric patients who underwent Deflux® treatment for VUR after RT from April 2008 to March 2022. ResultsSixty-eight pediatric patients underwent RT. VUR was subsequently detected in 22 (32 %) of these patients. Seven of the 22 patients (32 %) underwent Deflux® treatment to avoid renal dysfunction due to urinary infection (UTI). The median age at the time of RT was 4 years (range:2–12). All 7 patients had urinary UTIs before Deflux® treatment. The median estimated glomerular filtration rate (eGFR) before Deflux® treatment was 67 ml/min/1.73 m2 (range:42–138 ml/min/1.73 m2). After Deflux® treatment, VUR was downgraded in three cases (43 %). Four patients (57 %) experienced postoperative UTI, two of who underwent a second Deflux® treatment, one underwent submuscular tunnel reconstruction, and the other one experienced UTI without VUR after 1st Deflux® treatment but did not reoccur. All seven patients continued prophylactic medication after Deflux® treatment, without any history of recurrent UTIs during the observation period after treatment (median 37 months [range 7–86 months]). Furthermore, the eGFRs did not significantly decrease after Deflux® treatment (median eGFR 58 ml/min/1.73 m2 [range:33–99 ml/min/1.73 m2], p > 0.1). ConclusionDeflux® treatment for VUR after RT is technically challenging because the new ureteral orifice is ventrally anastomosed at the bladder. We believe our results indicate the possibility of reducing the frequency of UTIs and contributing to preservation of the renal function after RT. Type of studyRetrospective Study. Level of evidenceLevel III.

Comparative Effectiveness Randomized Clinical Trial Using Next-generation Microbial Sequencing to Direct Prophylactic Antibiotic Choice Before Urologic Stone Lithotripsy Using an Interprofessional Model

BackgroundNext-generation sequencing (NGS) methods for microbial profiling have increased sensitivity to detect urinary pathogens. ObjectiveTo determine whether NGS microbial profiling can be used to guide antibiotic prophylaxis and reduce infection compared with the standard of care. Design, setting, and participantsA prospective randomized controlled clinical trial of patients undergoing urologic stone interventions at an academic health center from December 2019 to January 2022 was conducted. Urine was collected at the preoperative visit for standard culture and intervention NGS diagnostics. Evaluable patients were culture negative, met 2-wk follow-up, and did not cancel surgery. Of 240 individuals (control = 121, intervention = 119), 83 control and 74 intervention patients were evaluable. InterventionMicrobial findings (paired quantitative polymerase chain reaction and NGS) were sent to an infectious disease pharmacist to recommend prophylactic antimicrobial regimen. Outcome measurements and statistical analysisThe primary outcome was postoperative urinary infection within the follow-up period (Fisher’s exact test). The primary outcome was analyzed by modified intent-to-treat (mITT) and per-protocol analyses. Secondary endpoints considered included positive culture concordance, antibiotic use, and adverse events. Additional post hoc analyses investigated factors contributing to infection (univariate logistic regression). Results and limitationsThe intervention significantly reduced postsurgical urinary infection risk by 7.1% (–0.73%, 15%) compared with the standard of care in the mITT analysis (1.4% vs 8.4%, p = 0.045) or by 8.5% (0.88%, 16%) compared with the per-protocol analysis (0% vs 8.5%, p = 0.032). NGS-guided treatment altered the distribution of antibiotics used (p = 0.025), and antibiotics poorly matched with NGS findings were associated with increased infection odds (odds ratio [OR] = 5.9, p = 0.046). Women were at greater odds to develop infection (OR = 10, p = 0.03) and possessed differentiated microbial profiles (p < 0.001). ConclusionsUrinary microbial NGS-guided antibiotic prophylaxis before endoscopic urologic stone lithotripsy improves antibiotic selection to reduce healthcare-associated urinary infections; however, treatment efficacy may be limited by the ability to adhere to the recommended protocol. Patient summaryWe investigated whether microbial DNA sequencing could improve the selection of antibiotics before kidney stone surgery in patients not known to have any bacteria in the urine on standard culture. We found that using microbe DNA to guide antibiotic choices decreased postoperative infection rate and may encourage individualized use of available antibiotics.

Antibiotic prophylaxis in flexible ureterorenoscopy with negative urine culture.

To improve susceptibility profiles of nosocomial bacteria, identifying the difference between infectious complications in patients undergoing endoscopic flexible ureterolithotomy (fURS) with negative urine culture (UC) that received extended antibiotic prophylaxis (EP) compared with standard antibiotic prophylaxis (SP). This is a retrospective, observational, analytical cohort study, comparing infectious complications between patients undergoing fURS with negative UC who received EP versus SP. We include patients with susccessfull fURS, <20-mm stones and complete information. Overall, 10.3% of patients had complications, 7.2% of patients had postoperative urinary infection, 1.8% had upper urinary tract infection (UTI) and 1.4% had urinary sepsis. Lower UTI were significantly more likely in the extended prophylaxis group with 6.8% versus 2.7% (RR =2.8; 95% CI: 1.10-7.37, p= 0.030). The risk of upper UTI and sepsis did not show significant differences. A total of 69% patients with postoperative infection had isolated multidrug-resistant bacteria (MDRB) in the UC, with a higher risk in patients with extended prophylaxis (RR =3.1; 95% CI: 1.33-7.59, p= 0.009). Patients with negative UC who underwent fURS using extended prophylaxis have two times higher risk of low UTI than patients with standard prophylaxis, without differences in the incidence of upper UTI or urinary sepsis. The risk of MDRB isolation in the postoperative UC is higher in the extended prophylaxis group, therefore we recommend the standard 60-min preoperative prophylaxis.

Impact of the implementation of Identification-Situation-Background-Assessment-Recommendation (ISBAR) tool to improve quality and safety measure in a lithotripsy and endourological unit.

A lack of professional communication and collaboration may be one of the main causes of medication errors. The objective was to evaluate the results of the implementation of ISBAR as a communication and safety tool in a Lithotripsy and Endourologic Unit of a tertiary public hospital. A total of 457 patients were included in a retrospective study from 2014 to 2019. Patients were divided into two groups: group A (357 patients) in which an endourological procedure was performed before march of 2018 (without the implementation of ISBAR tool) and Group B (100 patients) with the implementation of ISBAR tool. The inclusion criteria were patients accepted for surgical intervention by anaesthesiology Department and operated in the period of the study. The variables analysed included number of procedures, global, intraoperative and postoperative complications rate, urinary infection or sepsis, NPR (FMEA), percentage of suspended surgical patients and hospital stay. The postoperative complications showed no significant differences between groups, but a trend to diminishing was seen in the complication in the group B. The sepsis reduced its incidence and it was close to significant difference. The operative time was shorter in group B 119,11min (114,63-123,59) vs 115,11min (109,63-121,67) p = 0,3. The reduction in the main postoperative complication (sepsis) explained the lower hospital stay for group B. The severe adverse events detected were reduced completely. ISBAR tool was an effective patient safety tool improving quality care. To provide safe patient care and improving quality is indispensable an effective communication flow.

Enhanced recovery after retrograde intra-renal surgery (RIRS) in comparison with mini-percutaneous nephrolithotomy (Mini-PCNL) for renal stone treatment

The study presents a comparative analysis of the mini-percutaneous nephrolithotripsy (mini-PCNL) and retrograde nephrolithotripsy (RIRS) with a logistic analysis of outcomes and complications. The prospective study included 50 patients diagnosed with urolithiasis from 2018 to 2021 in the urological hospitals in Irkutsk. Patients were divided into two groups: RIRS (group I, n = 23) and Mini-PCNL (group II, n = 27). The comparison groups are statistically homogeneous. Both procedures equally lead to high stone free rates (SFR > 1 mm, 91.3% vs 85.1%; p = 0.867; SFR > 2 mm, 95.6% vs 92.5%; p = 0.936). The intergroup analysis of the total operation time (and lithotripsy) demonstrated similar times (p > 0.05). Postoperative complications of classes II-III (Clavien-Dindo) in the early and late postoperative period developed rarely and were comparable (p > 0.05). Class I complications were predominant in the PCNL group (p = 0.007). Some parameters demonstrated the superiority of RIRS over PCNL: less pronounced pain syndrome (p = 0.002), less drainage time (p < 0.001), no postoperative hematuria (p = 0.002), shorter hospitalization and total treatment period (p < 0.001). The study highlighted the positive effect of the one-day surgery principle on the risk of developing postoperative hematuria, urinary infection, or severe postoperative pain. RIRS and mini-PCNL have similar effectiveness, but RIRS meets the criteria of the enhanced recovery program more than PCNL.

MP59-14 REDEFINING CLINICALLY SIGNIFICANT HEMATURIA AFTER HOLMIUM ENUCLEATION OF THE PROSTATE

You have accessJournal of UrologyCME1 Apr 2023MP59-14 REDEFINING CLINICALLY SIGNIFICANT HEMATURIA AFTER HOLMIUM ENUCLEATION OF THE PROSTATE Laena Hines, Karen Doersch, Mark Ninomiya, Rajat Jain, and Scott O Quarrier Laena HinesLaena Hines More articles by this author , Karen DoerschKaren Doersch More articles by this author , Mark NinomiyaMark Ninomiya More articles by this author , Rajat JainRajat Jain More articles by this author , and Scott O QuarrierScott O Quarrier More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003312.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Holmium enucleation of the prostate (HoLEP) is offered for symptomatic prostatic enlargement at high risk for bleeding. However, prior studies define clinically significant hematuria (CSH) narrowly as return to operating room or need for transfusion. We sought to evaluate risk factors contributing to a broader definition of CSH which may contribute to alteration of clinical course. METHODS: We retrospectively analyzed 115 patients who underwent HoLEP at a single institution across two surgeons from November 2020 to October 2022. HoLEP was performed using Moses 2.0 (Boston Scientific) laser and the Piranha enucleation system (Richard Wolf). We defined CSH broadly: clot retention, return to operating room, perioperative management variation due to hematuria, office calls for hematuria, or continued gross hematuria past one month post operatively. Pearson Chi-squared, univariable and multivariable analysis were used where appropriate. Multivariable analysis of CSH risk based on use of antiplatelet agents or anticoagulants included correction for age, enucleation time (surrogate for case difficulty), post-operative urinary infection, and prostate volume. RESULTS: 25.3% (29/115) of our patients developed CSH after HoLEP. 42.86% of patients on antiplatelets and 31.25% on anticoagulants had significant hematuria, compared to 20.78% on neither (p=0.18). Longer enucleation time was a risk factor for developing CSH (Univariate OR 1.01, p=0.05). Neither antiplatelets nor anticoagulants were a risk factor (p=0.17; p=0.30). CONCLUSIONS: With a broadened definition, 25% of patients developed CSH following HoLEP, which impacted the clinical course. Our data suggests that the current definition of significant hematuria is too narrow and does not capture many patients whose clinical course is affected by hematuria. While longer enucleation time was a risk factor for developing CSH hematuria, we found no difference in CSH with patients on antiplatelets or anticoagulants compared to controls, though larger studies are needed. Source of Funding: n/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e813 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Laena Hines More articles by this author Karen Doersch More articles by this author Mark Ninomiya More articles by this author Rajat Jain More articles by this author Scott O Quarrier More articles by this author Expand All Advertisement PDF downloadLoading ...

Total Knee Arthroplasty After Genicular Nerve Radiofrequency Ablation: Reduction in Prolonged Opioid Use Without Increased Postsurgical Complications.

Introduction:Genicular nerve radiofrequency ablation (GNRFA) is an increasingly used nonsurgical treatment modality for patients with advanced knee osteoarthritis. Previous studies have demonstrated this to be an effective and safe method to decrease pain and increase functionality in this patient population. The purpose of this study was to compare 2-year postoperative complication rates and rates of prolonged postoperative opioid usage between patients undergoing total knee arthroplasty (TKA) after previous GNRFA and those undergoing TKA alone.Methods:Patients who underwent primary TKA after prior GNRFA (GNRFA-TKA) of the ipsilateral knee were identified in a national all-payer claims database from 2010 to 2019. Univariate and multivariable analyses were conducted comparing those with prior GNRFA and those without. Outcomes of interest included prolonged postoperative opioid usage, 2-year revision rates, and 90-day medical complications. Statistical analysis was conducted using R software provided by the PearlDiver Database.Results:In total, 675 patients in the GNRFA-TKA cohort were compared with a control cohort of 255,351 patients. Genicular nerve radiofrequency ablation-total knee arthroplasty patientshad lower odds of prolonged opioid use postoperatively (OR: 0.478; 95%: 0.409 to 0.559; P < 0.001). No notable difference was observed in the 2-year surgical outcomes between cohorts. Patients in the GNRFA-TKA cohort had lower odds of requiring a blood transfusion and having postoperative anemia, all arrhythmias, and urinary infections compared with primary TKA control patients.Conclusion:Preoperative GNRFA leads to a lower rate of prolonged postoperative opioid use in patients undergoing TKA, without an increased risk of complications. Future prospective studies are needed to validate the findings of this database study.

How-I-do-it: minimally invasive repair of ileal conduit parastomal hernias.

Parastomal hernia after radical cystectomy and ileal conduit urinary diversion is an underestimated and undertreated condition with significant impact on quality of life. However, its surgical treatment is challenging and prone to complications and the optimal surgical treatment of this condition remains to be determined. In this article, we describe our surgical techniques in the minimally invasive treatment of ileal conduit parastomal hernia and present our preliminary results. In a retrospective single-center design, a prospectively maintained database was screened. Data from all patients undergoing surgical treatment for a parastomal hernia after cystectomy and ileal conduit urinary diversion in our center were collected. Between May 2016 and June 2020, 15 patients underwent minimally invasive repair of a parastomal hernia of an ileal conduit. Details on the surgical approach are provided, along with a flow chart to standardize the choice of surgical technique, depending on the presence of a concomitant midline incisional hernia and perioperative findings. The majority of patients were treated with robotic-assisted laparoscopic surgery (10/15; 66.7%). Median postoperative hospital stay was 5days. One-third of patients developed a postoperative urinary infection. Median follow-up was 366days. One patient developed a local recurrence of her parastomal hernia on day 66 postoperatively, treated with intraperitoneal mesh. The minimally invasive surgical treatment of a parastomal hernia after ileal conduit urinary diversion poses specific perioperative challenges that require a broad surgical armamentarium and a tailored approach. Preliminary results confirm a significant morbidity after this type of surgery.

Risk factors for urinary infection after retrograde upper urinary lithotripsy: Implication for nursing.

There are needs to evaluate the risk factors for urinary infection after retrograde upper urinary lithotripsy, to provide insights into the management and nursing care of patients with retrograde upper urinary lithotripsy.Patients who received retrograde upper urinary lithotripsy with a Foley 20 urinary tube insertion from June 1, 2019 to December 31, 2020 in our hospital were selected. Patients were grouped urinary infection and no infection group according to the culture results of urine, and the clinical data of the 2 groups of patients were collected and compared. Single factor and logistic regression analysis were used to analyze the risk factors of urinary tract infection after retrograde upper urinary lithotripsy.Four hundred ten patients with retrograde upper urinary lithotripsy were included, of whom 62 patients had the urinary tract infection, the incidence of urinary tract infection was 15.12%. There were significant differences in the gender, age, diabetes, stone diameter, duration of urinary tube insertion and duration of surgery between infection and no-infection group (all P < .05). The Escherichia coli (62.90%) was the most commonly seen bacterial in patients with urinary tract infection. Female (odds ratio [OR]: 1.602, 95% confidence interval 95% [CI]: 1.132∼2.472), age >50 years (OR: 2.247, 95% CI: 1.346∼3.244), diabetes (OR: 2.228, 95% CI: 1.033∼3.451), stone diameter ≥2 cm (OR: 2.152, 95% CI: 1.395∼3.099), duration of urinary tube insertion ≥3 days (OR: 1.942, 95% CI:1.158∼2.632), duration of surgery ≥90 minutes (OR: 2.128, 95% CI: 1.104∼3.846) were the independent risk factors for the postoperative urinary tract infection in patients with retrograde upper urinary lithotripsy (all P < .05).The incidence of urinary tract infection in patients undergoing retrograde upper urinary lithotripsy was high, counteractive measures targeted on those risk factors are needed to prevent and reduce the postoperative urinary infection in clinical settings.

The effect of ideal urine culture time on urinary infections after flexible ureteroscopy: A match‐pair case‐control study

To investigate the effect of the ideal period (Δ-day), which is a period between the sterile urine culture and initiation of flexible ureteroscopy (f-URS), on postoperative urinary tract infections (UTI) in our tertiary referral centre. After obtaining the approval of the local ethics committee, retrospective data were collected for all f-URS procedures performed between January 2017 and March 2019. Patients that developed UTI were matched in 1:1 proportion with patients that did not develop UTI based on their demographic and stone characteristics. The group of patients with postoperative UTI was compared with the control group. A total of 916 f-URS cases that had all required data were analysed. Sixty-eight patients with postoperative UTI were determined and a total of 136 patients were included in the study after match-pair. We found that if the Δ-day is longer than 2weeks, the possibility of postoperative urinary infection rates increases with statistical significance (P=.006). According to our subgroup analysis, postoperative UTI was more common if the Δ-day >14days. ROC curve analysis provided a 14.5-day period as a cut-off value of Δ-day for postoperative UTI. The present study is the first to examine the impact of the Δ-day for f-URS on postoperative UTIs. In brief, prolonging the Δ-day, especially if Δ-day >14days, leads to an increase in the rates of postoperative UTI. We conclude that it is preferred to either perform the f-URS in the early period after the urine culture analysis or doing the urine culture analysis shortly before the surgery.

Indwelling catheters increase altered mental status and urinary tract infection risk: A retrospective Cohort Study

BackgroundAlthough indwelling urinary catheters (IUCs) are used intraoperatively and may cause complications (e.g., delirium), only few robust studies have investigated the association between intraoperative IUC use and complications. We hypothesized that IUC use might increase the postoperative incidence of altered mental status and/or urinary catheter infection. Materials and methodsIn this retrospective single-center cohort study, we analyzed the data of adult patients undergoing surgery at our facility between January 2013 and December 2018. The primary endpoint was altered mental status and/or incidence of urinary catheter infections. The patients were divided into IUC and control groups. A multivariable logistic regression model was used to identify the predictors of postoperative complications, and a multivariable Cox proportional hazards regression model was used to analyze hospital discharge in unmatched and inverse propensity-weighted patients. ResultsOf the 14,284 patients that were reviewed, we analyzed 5112 patients (control group, 44.0%; IUC group, 56.0%). Almost all procedures comprised less invasive surgeries. The prevalence of postoperative altered mental status and postoperative urinary catheter infection were 3.56% and 0.04%, respectively. After inverse propensity weighting, all baseline characteristics were similar between the two groups. However, patients with IUCs had a higher risk of postoperative complications (adjusted odds ratio, 1.97; 95% confidence interval [CI], 1.50–2.59) and prolonged hospital stays (hazard ratio, 0.84; 95% CI, 0.80–0.89). ConclusionIn patients undergoing less invasive surgery, IUCs may be associated with a relatively high risk of altered mental status or urinary catheter infection. These data may facilitate preoperative discussions regarding the perioperative use of IUCs.

Robotic-assisted versus open simple prostatectomy: Results from a systematic review and meta-analysis of comparative studies.

PurposeTo review safety and efficacy of robotic-assisted simple prostatectomy (RASP) compared to open simple prostatectomy (OP).Materials and MethodsA comprehensive literature search was performed to assess the differences in perioperative course and functional outcomes in patients with benign prostatic hyperplasia and surgical indication. The incidences of complications were pooled using the Cochran–Mantel–Haenszel Method and expressed as odds ratio (OR), 95% confidence interval (CI), and p-values. Perioperative course and functional outcomes were pooled using the inverse variance of the mean difference (MD), 95% CI, and p-values. Analyses were two-tailed and the significance was set at p<0.05.ResultsEight studies were accepted. Meta-analysis showed significantly longer surgical time (MD, 43.72; 95% CI, 30.57–56.88; p<0.00001) with a significantly lower estimated blood loss (MD, -563.20; 95% CI, −739.95 to −386.46; p<0.00001) and shorter postoperative stay (MD, −2.85; 95% CI, −3.72 to −1.99; p<0.00001) in RASP. Catheterization time did not differ (MD, 0.65; 95% CI, −2.17 to 3.48; p=0.65). The risk of blood transfusion was significantly higher in OP (OR, 0.23; 95% CI, 0.17–0.33; p<0.00001). The risk of recatheterization (OR, 1.96; 95% CI, 0.32–11.93; p=0.47), postoperative urinary infections (OR, 0.89; 95% CI, 0.23–3.51; p=0.87) and 30-day readmission rate (OR, 0.96; 95% CI, 0.61–1.51; p=0.86) did not differ. At 3-month follow-up, functional outcomes were similar.ConclusionsRASP demonstrated a better perioperative outcome and equal early functional outcomes as compared to OP. These findings should be balanced against the longer operative time and higher cost of robotic surgery.

A cut-off value for the operation time and other risk factors in terms of the infection risk for flexible ureterorenoscopy.

To investigate the operation time (OT) and ureteral access sheath (UAS) usage with the infection rates and to determine a cut-off value for OT. We retrospectively analysed the data of the patients who underwent flexible ureterorenoscopy (FURS) for renal stones larger than 20mm between 2010 and 2019. The investigated parameters were OT, UAS using, and infection status. The data were analysed by forming two groups according to whether the OT was less than 60minutes and more, whether the UAS was used and whether an infection occurred. In addition, independent risk factors that may affect postoperative urinary infection development were also investigated by logistic regression analysis. And, a Receiver Operating Characteristic (ROC) curve analysis was applied to determine a cut-off value in OT terms, where infection rates increase more. A total of 575 patients were enrolled in the study. The rates of the usage of UAS and infection were greater statistically in the group for longer than 60minutes. OT was longer statistically in the infection group than in the group without infection (94.1±14.2 and 68.01±23.1, for groups 1 and 2, respectively, P<.05, Table 2). OT was statistically longer in the UAS group than the unused one (79.3±24.4 and 66.7±22.4, for groups 1 and 2, respectively, P<.05, Table 3). ROC analyses revealed a cut-off point of 87.5min for OT in terms of infection rate. While the infection risk increases when OT exceeds 60minutes, FURS can be safely performed up to 87.5minutes with 89% sensitivity and 69% specificity infection risk.

Meta-analysis of the effect of cemented and uncemented hemiarthroplasty on displaced femoral neck fracture in the elderly.

The present meta-analysis was designed to systematically evaluate the effect of cemented and uncemented hemiarthroplasty on femoral neck fractures in the elderly and its effect on intraoperative bleeding and postoperative complications. Pubmed, Embase, the Cochrane Library, CNKI and WANFANG databases were retrieved and retrieval time was from inception to February 2019. Operative time, intraoperative blood loss, length of hospital stay, postoperative complications and postoperative mortality were compared between cemented and uncemented hemiarthroplasty. RevMan 5.3 statistical software was used for analysis. A total of 16 randomized controlled trials were included, with a total of 2,384 patients undergoing hemiarthroplasty. The cemented group had a longer operation time [weighted mean difference (WMD)=7.07, 95% confidence interval (CI)=3.91-10.23, P<0.0001], but it had lower incidence of intraoperative and postoperative fracture around the prosthesis (OR=0.25, 95% CI=0.13-0.47, P<0.0001) and shorter length of hospital stay (WMD=-1.78, 95% CI=-13.38--0.17, P=0.03). There was no significant difference in pulmonary embolism, mortality, lower extremity deep vein thrombosis rate, joint dislocation rate, intraoperative blood loss and postoperative incidence of lung, urinary system and incision infection between the two groups. To summarize, compared with the uncemented group, the cemented group had long operation time and a high incidence of pulmonary embolism, but had an advantage in reducing the risk of periprosthetic fractures. In addition, cemented hemiarthroplasty did not increase the mortality rate, the rate of deep vein thrombosis in lower extremities, the rate of joint dislocation, intraoperative blood loss, and the incidence of postoperative pulmonary, urinary, and incision infections.

Postoperative urinary tract infection after ureteroscopic lithotripsy in patients with asymptomatic bacteriuria

Background/Aim. Postoperative urinary tract infection (UTI) is one of the most common infective complications of ureteroscopic lithotripsy. Preoperative asymptomatic bacteriuria is not a contraindication for performing ureteroscopic lithotripsy but it can be a significant risk factor for occurrence of severe forms of postoperative urinary infection. Methods. From January 2010 until December 2014 at the Urology Clinic of the Military Medical Academy in Belgrade, 389 patients undergoing ureteroscopic lithotripsy were analyzed, and their postoperative infective complications were monitored. From the group, the incidence of posteoperative urinary infection was analysed in 52 patients with preoperative asymptomatic bacteriuria. Results. Infective complications occured in 18.7% of patients, and postoperative UTI in 10% of patients. Out of 52 patients with preoperative asymptomatic bacteriuria, 36.5% had postoperative urinary tract infection (?2 = 46.773; p &lt; 0.001). In these patients, we registered higher frequency of severe forms of postoperative UTI, systemic inflammatory response syndrome (SIRS) and sepsis. Conclusion. Preoperative asymptomatic bacteriuria represents a significant risk factor for developing postoperative UTI following ureteroscopic lithotripsy and is associated with increased risk for occurence of severe forms of SIRS and sepsis. It is desirable that every patient with indicated ureteroscopic lithotripsy has sterile urine culture, and if this is impossible to achieve, a special caution and an adequate antibiotic therapy and prophylaxis are needed before and during the surgical procedure

Ureteroscopic holmium laser lithotripsy for the treatment of renal calyx calculi and its effect on renal pressure

Objective To observe the effect of ureteroscopic holmium laser lithotripsy on renal calyx calculi and its effect on renal pelvis pressure. Methods The clinical data of 80 patients with lower renal calyx stones treated in our hospital from August 2016 to August 2017 were retrospectively analyzed and divided into the control group and the observation group, each group with 40 cases. The control group was treated with percutaneous nephrolithotomy, and the observation group was treated with ureteroscopic holmium laser lithotripsy. The perioperative general conditions of the two groups were observed, and the differences of intrapelvic pressure, renal function and complications between the two groups were compared. Results The time of operation and the time of hematuria in the observation group were shorter than the control group, the rate of lithotripsy was higher than that of the control group. There was no difference between the two groups in the intraoperative intraoperative pressure of the renal pelvis; the two groups had no difference in renal function before treatment. After the treatment, the renal function of the two groups had no obvious changes before the treatment. In the 1 month after treatment and 3 months after treatment, the IPSS and QOL were lower than the control group (P<0.05), and the Qmax was higher than that of the control group (P<0.05). There was no significant difference in the incidence of postoperative renal pain, temporary incontinence and urinary tract infection in the two groups (χ2=0.721, P=0.396). Conclusions Ureteroscopic holmium laser litho-tripsy has good therapeutic effect on lower renal calyx stone. It has no adverse effect on renal pelvis pressure and renal function, and can obviously improve the prognosis of the patients. It has good application value. Key words: Kidney Calculi; Ureteroscopy; Lasers, Solid-State; Pressure

Complicaciones intraoperatorias y posoperatorias de las cintas medio uretrales libres de tensión en incontinencia urinaria de esfuerzo

Antecedentes: La colocación de cintas medio uretral son actualmente el tratamiento de primera línea para la incontinencia urinaria de esfuerzo. El objetivo fue evaluar las complicaciones intra y posoperatorias de las cintas transobturadora y retropúbica; y los factores de riesgo asociados.&#x0D; Material y métodos: Estudio de cohorte retrospectivo en 105 mujeres durante el 2016 a 2018. Se dividió en dos grupos: TVT (n=28) y TOT (n=77). Se analizaron variables demográficas, factores de riesgo, complicaciones intra y posoperatorias. Se realizo estadística descriptiva y correlación de variables con programa SPSS v17.0, y p ≤ 0.05 estadísticamente significativo.&#x0D; Resultados: La edad promedio fue 56.7 ± 8.8 años; 31.4% (n=33) con incontinencia de esfuerzo, 65.7% (n=69) con incontinencia mixta (IUM) y 2.9% (n=3) con incontinencia oculta. La tasa de complicación global fue de 29.5% (n=31). La complicación intraoperatoria común fue la perforación vesical 3.8% en el grupo TVT asociada a obesidad (OR 12.9). Las complicaciones posoperatorias estuvieron relacionadas con la TOT (p=0.049), compuestas por infección de vías urinarias (11.4%), inguinodinea (7.6%) y otras (6.9%). El riesgo de infección urinaria posoperatorio estuvo asociado con incontinencia de esfuerzo (p=0.03), ausencia de tratamiento de incontinencia urinaria mixta (p=0.04); aumentado la tasa de incontinencia urinaria de urgencia de novo.&#x0D; Conclusiones: El enfoque transobturador tiene bajos índices de complicaciones transoperatorias en comparación con la retropúbica. La complicación más común en nuestra serie fue la infección urinaria por lo que se requieren estudios prospectivos aleatorizados.

Effect of rapid rehabilitation surgery on plasma prostatectomy in elderly patients with benign prostatic hyperplasia

Objective To analyze the effect of rapid convalescence surgery on plasma radical prostatectomy in elderly patients with prostate hyperplasia. Methods A total of 140 elderly patients with prostate hyperplasia who underwent plasma prostatectomy in our hospital from January 2016 to August 2017 were selected as subjects. Divide them into control group (70 cases) and observation group (70 cases) according to random number table method. Patients in the control group were given routine care. The observation group gave a nursing model based on the concept of rapid rehabilitation surgery on the basis of the control group. Compared the bladder irrigation time, postoperative hospitalization time, catheter removal time, anal exhaust time, first time out of bed time, complication rate, postoperative Numerical Rating Scale (NRS) pain score, bladder spasm symptom score and quality of life score between the two groups. Results The bladder irrigation time, postoperative hospital stay, urinary catheter removal time, anal exhaust time and first time to get out of the observation group were (23.94±3.75) h, (3.49±0.46) d, (3.11±1.50) d, 6.23±3.07) h and (24.70±3.62) d, while the control group were (76.42±9.55) h, (7.06 ±0.44) d, (6.74±2.06) d, (17.41±3.48) h and (90.58±9.75) d, the above observation indexes of the observation group were significantly lower than the control group, the difference was statistically significant (t=11.918-52.998, P<0.01). The incidence of postoperative bladder spasm, bloating, hemorrhage, lung infection and urinary tract infection in the observation group were 1.429% (1/70), 2.857% (2/70), 0, 2.857% (2/70) and 7.143% (5/70), respectively, while the control group were 11.429% (8/70), 14.286% (10/70), 8.571% (6/70), 15.714% (11/70) and 24.143% (19/70), respectively. The incidence of the above complications in the observation group was significantly lower than that of the control group, the difference was statistically significant (χ2=4.275-8.499, P<0.05 or 0.01). The NRS pain score, quality of life score and bladder spasm score were observed in the observation group (31.48±3.60), (1.89±1.03), (2.25±0.47) points, while the control group were (36.20±4.22), (2.77±1.84), and (3.79±0.81) points, respectively. The above three scores in the observation group were significantly lower than those in the control group, the difference was statistically significant (t=7.119, 3.491, 13.756, P<0.01).The nursing satisfaction of patients in the observation group was 95.71% (67/70) which was significantly higher than 80.00% (56/70) of the control group, the difference was statistically significant (χ2=6.695, P<0.05). Conclusions Rapid rehabilitation surgery for patients with advanced prostatic hyperplasia with plasma prostatectomy can speed up the recovery process, relieve postoperative pain, reduce the incidence of postoperative complications, harmonious doctor-patient relationship, improve the quality of life of patients, it is worthy of extensive clinical promotion. Key words: Rapid rehabilitation surgery; Prostatic hyperplasia; Plasma prostatectomy

Possible risk factors for postoperative urinary tract infection following ureteroscopic lithotripsy

Background/Aim. Ureteroscopic lithotripsy is today a safe method of endoscopic destruction of stone in the kidney and ureter with a small number of complications of which the most common is postoperative urinary tract infection. Risk factors for the occurrence of urinary tract infection after the ureteroscopic destruction of stones in the ureter and kidney are not clearly defined in the previous studies. Methods. The study included 389 patients with ureteroscopic lithotripsy and possible risk factors were analyzed: age of the patients, sex, diabetes presence, degree of hydronephrosis, stone size, stone localization, wear of ureteral JJ stent and percutaneous nephrostomy catheter, type of surgical procedure and duration of the operation. The frequency of postoperative urinary tract infection was statistically analyzed in relation to the possible risk factors. Results. Ten percent of the patients had postoperative urinary tract infection. The higher incidence of postoperative urinary tract infection was found in patients with diabetes (?2 = 22.918; p &lt; 0.001), those who before surgery carried a ureteral JJ stent (?2 = 4.620; p = 0.040) and percutaneous nephrostomy catheter (?2 = 8.240; p = 0.004), who had a larger stone (?2 = -3.301; p = 0.001), and whose surgery lasted longer (t = 4.261; p &lt; 0.001). Conclusion. The frequency of postoperative urinary infection and risk factors for its emergence in our study are in line with the results of studies by other authors. Patients with diabetes, who preoperatively carried JJ stent or a percutaneous nephrostomy catheter, who had large stones and in which the operating time is longer have a greater risk of developing postoperative urinary tract infection. Accordingly, the importance of identifying these patients in the preparation for ureteroscopic lithotripsy contributes to the appropriate preoperative preparation and decreases the frequency of postoperative urinary tract infection to a minimum.