Rate Of Urosepsis Research Articles

MP68-03 UROSEPSIS FOLLOWING URETERORENOSCOPY FOR THE TREATMENT OF UROLITHIASIS OR UPPER URINARY TRACT TRANSITIONAL CELL CARCINOMA: A FOCUS ON UNDERESTIMATED AND HARMFUL POSTOPERATIVE COMPLICATION

You have accessJournal of UrologyStone Disease: Surgical Therapy VI1 Apr 2017MP68-03 UROSEPSIS FOLLOWING URETERORENOSCOPY FOR THE TREATMENT OF UROLITHIASIS OR UPPER URINARY TRACT TRANSITIONAL CELL CARCINOMA: A FOCUS ON UNDERESTIMATED AND HARMFUL POSTOPERATIVE COMPLICATION Luca Villa, Filippo Pederzoli, Francesco Trevisani, Alberto Briganti, Andrea Salonia, and Francesco Montorsi Luca VillaLuca Villa More articles by this author , Filippo PederzoliFilippo Pederzoli More articles by this author , Francesco TrevisaniFrancesco Trevisani More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , and Francesco MontorsiFrancesco Montorsi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2319AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The reported rate of infectious complications following ureterorenoscopy (URS) for the treatment of patients with either urinary stones or low-risk upper urinary tract transitional cell carcinoma (UUT-TCC) is reasonably low. We investigated the rate of urosepsis following URS in our series and looked for predictors of postoperative infectious events. METHODS We identified 99 patients submitted to URS with intracorporeal holmium:YAG laser lithotripsy for ureteral and/or renal stones (n=71) or with laser tumour photoablation for suspicion of UUT-TCC (n=28) throughout the last 12 consecutive months. A preoperative urine culture was routinely obtained and any concomitant urinary tract infection (UTI) was treated prior surgery. Antibiotic prophylaxis (i.e., second generation cephalosporin) was offered preoperatively. A ureteral access sheath 10/12 Fr was used when an intrarenal procedure was scheduled. Descriptive statistics was used to detail clinical features of the whole cohort of patients. Urosepsis was defined using the Third International Consensus Definitions for Sepsis and Septic Shock. Chi-square and independent T-test assessed differences among patients with and without urosepsis following URS. All tests were two-sided with a significance level set at p < 0.05. RESULTS 89 patients (89.9%) had elective admission to our department, and 10 patients (10.1%) were admitted through the emergency room. Seven patients (7.1%) developed urosepsis, four (4%) advanced to septic shock, and one (1%) eventually died. Patients who developed urosepsis compared with their counterparts who did not develop urosepsis more frequently had a stone or tumour in the intrarenal cavities rather than in the ureter (100% vs. 50%, respectively), a previous history of UTI (57.1 % vs. 13%, respectively), access to our department through the emergency room (42.8% vs. 7.6%, respectively), longer hospital stay prior to surgery (mean = 6 vs. 0.5 days, respectively), and higher burden of comorbid conditions (Charlson Comorbidity Index ≥3 = 43.8% vs. 18.4%, respectively) (all p< 0.01). Conversely, the rate of urosepsis following URS for the treatment of stones and UUT-TCC did not vary significantly (5.6% and 10.7%, respectively; p=0.4). CONCLUSIONS Proper counselling of patients candidate to URS for either ureteral/renal stones or UUT-TCC who have comorbid conditions or certain clinical features is mandatory, as the risk of severe urosepsis in these categories of patients is not negligible. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e919 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Luca Villa More articles by this author Filippo Pederzoli More articles by this author Francesco Trevisani More articles by this author Alberto Briganti More articles by this author Andrea Salonia More articles by this author Francesco Montorsi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Percutaneous Nephrolithotomy with Amplatz and Alken Dilators: An Eight-Year Single Tertiary Care Centre Experience.

BackgroundPercutaneous nephrolithotomy (PNL) is the standard procedure for patients with renal stones over 2 cm in diameter. We analyzed complications after this procedure focusing on two different methods of tract dilation.Material/MethodsBetween August 2008 and April 2016 222 percutaneous nephrolithotomies were performed in a total of 208 patients. The Group I (n=123) comprised patients where Alken dilatators were used, while Group II (n=99) comprised patients where Amplatz dilators were used. Efficacy was examined based on ultrasound and x-ray examination one month after the procedure. Complications were recorded using Clavien Dindo classification.ResultsEfficacy was 85.3% and 86.8% in group I and II, respectively (p=0.77). Grade I complications were present in 14.6% and 3%, grade II were present in 9.7% and 8%, grade IIIa were present in 2.4% and 2%, grade IIIb were present in 1.6% and 2%, grade IVa were present in 1.6% and 7%, grade IVb were present in 3.2% and 1% in Group I and Group II, respectively. These differences were statistically significant (p=0.03).ConclusionsEfficacy was comparable between Alken dilator and Amplatz dilator groups. In group I, there were more postoperative fevers >38.5 °C and a higher rate of urosepsis. On the other hand, in group II we observed more pleural injuries. All differences resulted from the type of access to the kidney (inter/infracostal), punctured calyx, and utilization (or not) of access sheath rather than type of dilators itself.

The comparison of the influence between two different bowel preparation methods on sepsis after prostate biopsies.

IntroductionTransrectal ultrasonography (TRUS) guided prostate needle biopsy has been performed to diagnose and stage prostate cancer for many years. There are many different bowel preparation protocols to diminish the infectious complications, but there is no standardized consensus among urologists. Therefore, we aimed to assess two different bowel preparation methods on the rate of infectious complications in patients who underwent TRUS–guided prostate biopsy.Material and methodsA total of 387 cases of TRUS–guided prostate biopsy were included in this retrospective study. All patients received antibiotic prophylaxis with ciprofloxacin (500 mg) twice a day orally for 7 days starting on the day before the biopsy. The patients were divided into two groups according to the bowel preparation method used. Patients (Group 1, n = 164) only received self–administrated phosphate enema) on the morning of the prostate biopsy. Other patients (Group 2, n = 223) received sennasoid a–b laxatives the night before the prostate biopsy. Infectious complications were classified as sepsis, fever (greater than 38°C) without sepsis, and other clinical infections.ResultsMajor complications developed in 14 cases (3.8%), including 3 cases (0.8%) of urinary retention, and 11 (3%) infectious complications, all of which were sepsis. There were 3 and 8 cases of urosepsis in Group 1 and Group 2, respectively. There were no statistically significant differences between both Groups regarding to the rates of urosepsis (p = 0.358).ConclusionsDespite both methods of bowel preparation, sodium phosphate enema or sennasoid a–b calcium laxatives, before TRUS–guided prostate biopsy have similar effect on the rate of urosepsis, so both methods of bowel preparation can be safely used.

Prophylactic using of levofloxacin in transrectal prostate biopsy: a prospective, multicenter, randomized, effective drug control and open-label clinical study

Objective To find an efficacy,safety and economic prophylactic regimen after the transrectal ultrasound-guided prostate biopsy (TRUSPBs) by comparing the results of infection complications after the oral levofloxacin application with other intravenous prophylaxis antibiotics.Methods It was a prospective,randomized,multicenter,effective drug control and open-label clinical study.From October 2011to December 2012,296 patients who had indications of prostate biopsy in 8 medical centers were randomized into two groups:test group (n=150,levofloxacin,500 mg,po,qd for 3 days) and control group (n=146 intravenous antibiotics of any kinds,3 days).All those antibiotics were used on the day of biopsy and within two days after the biopsy.The average age in test group and control group was (67.6±8.6) years vs (68.7± 8.8) years,the average PSA level in test group and control group was (105.8±638.1) μg/L vs (174.6±861.4) μg/L,respectively (P＞0.05).In test group and control group,the mean duration of present illness was (0.6±2.3) months and (0.4± 1.2) months.The positive rate after the digital rectal examination was 45.3％ (68/150) in test group and 51.4％ (75/146) in control group.All patients underwent TRUSPB.The infectious complications and the expenditure of medicine in two groups were compared.Results The occurrences of infection complications in test group and control group were 6.0％ (9/150) and 6.2％ (9/146).Meanwhile,the rate of asymptomatic bacteriuria was 4.7％ (7/150) in test group and 3.4％ (5/146) in control group.In those groups,the rate of symptomatic urinary tract infection was 0 vs 0.7％ (1/146),the rate of fever was 0 vs 0.7％ (1/146),the rate of bacteremia was 1.3％ (2/150) vs 0 and the rate of urosepsis was 0 vs 1.4％ (2/146),respectively (P＞0.05).The average costs of medicine in test group and control group were (43.0±3.8) yuan and (403.7±277.6) yuan,respectively (P＜0.05).Conclusions Levofloxacin (500 mg,po,qd for 3 days) is an effective and safe regimen for infection prevention after the TRUSPB.Additionally,levofloxacin 500 mg 3 days regimen has significant cost benefit as well. Key words: Levofloxacin; Transrectal prostate biopsy; Infection; Prophylaxis

The Risk of Urosepsis in Patients Undergoing Fiducial Marker Placement for Image Guided Radiation Therapy (IGRT) of Prostate Cancer

To determine the risk of urosepsis after the placement of intraprostatic soft tissue fiducial markers used for IGRT for prostate cancer. Between June 2008 and December 2012, 3851 patients underwent fiducial-based kV (stereoscopic or CBCT) prostate IGRT for prostate cancer at our institution and serve as the population base for this study. Two gold soft-tissue markers (1 cm Visicoil) were implanted into the prostate by the Radiation Oncologist or Urologist using transrectal ultrasound via an 18 gauge pre-loaded needle in the right and left peripheral lobes of the prostate. All patients received prophylactic antibiotics prior to and after the procedure. Additional prep included temporary discontinuation of anticoagulants and typically a commercially available enema such as Fleets prior to the procedure to clear the rectal vault. Beginning in 2009, as part of our ongoing quality management processes, we instituted a standardized antibiotic prophylaxis regimen based on regional antibiogram which included double antibiotics, a mechanical double enema prep (night before and day of procedure instead of day of only), and a one hour delay between the procedure and any intramuscular injection of an antibiotic. Data was collected both on an on-going basis, as well as via a query of Radiation Oncology and Urology Electronic Medical Records (cross-referencing fiducial marker placement codes with subsequent sepsis hospitalization or treatment, with confirmation of generated data via hospital record review and/or direct patient and physician contact. A total of 7702 fiducials were inserted in 3851 patients for fiducial-based kV prostate IGRT. Of those, 31 patients developed urosepsis attributable to the placement of fiducial markers yielding a urosepsis rate of 0.8% per patient or 0.4% per marker placed. The number of cases of urosepsis fell over time with 65% (20/31), 22% (7/31), 6% (2/31), and 6% (2/31) of the cases occurring in 2008-2009, 2010, 2011, and 2012, respectively. Although the rate of urosepsis was only 0.8% overall, this rate significantly decreased by 2011 and remained low in 2012. Based on one of the largest cohorts of patients undergoing fiducial-based kV IGRT for prostate cancer, the risk of urosepsis due to implantation of soft-tissue fiducial markers for IGRT is extremely low. The routine use of double antibiotic prophylaxis, double enema (night before and day of procedure instead of day of only), and a one hour delay between the procedure and intramuscular injection of an antibiotic has decreased the incidence of urosepsis following fiducial marker placement. This decline in the sepsis rate is directly attributable to our institution's quality management measures which allowed for the standardization of the regimen prior to fiducial placement.