Risk factor for urosepsis after transurethral ureterorenoscopic holmium laser lithotripsy

doi:10.3877/cma.j.issn.1674-0785.2022.02.001

Abstract

Abstract:

Objective

To identify the risk factors for urinary sepsis after transurethral ureteropyeloscopic holmium laser lithotripsy (URSL).

Methods

Clinical data of patients with upper urinary calculi treated by URSL at Peking University Shougang Hospital from June 2015 to December 2020 were retrospectively analyzed, and the patients were divided into either a postoperative sepsis group (21 cases) or a non-sepsis group (1086 cases) according to the development of postoperative sepsis or not. Gender, age, body mass index (BMI), diabetes, calculus location, calculus size, CT value, operation time, preoperative indwelling of ureteral stents, preoperative urinary tract infection, preoperative obstructive pyelonephritis, preoperative urine bacterial culture, and surgical methods were compared between the two groups to identify the risk factors for urosepsis after URSL.

Results

A total of 1107 patients were enrolled, of whom 21 (21/1107) met the diagnostic criteria for urinary sepsis. Compared with the non-sepsis group, there were statistically significant differences in BMI, stone size, operation time, preoperative obstructive pyelonephritis, preoperative urine bacterial culture, and surgical methods in the sepsis group (P＜0.05). Multivariate Logistic regression analysis showed that operative time, preoperative obstructive pyelonephritis, and positive preoperative urine bacterial culture were risk factors for postoperative urinary sepsis (OR=1.157, 95% CI: 1.026~1.305, P=0.018; OR=4.733, 95%CI: 1.274~17.573, P=0.020; OR=5.287, 95%CI: 1.408~19.857, P=0.014).

Conclusion

For patients with obstructive pyelonephritis and positive urine bacterial culture caused by upper urinary calculi before surgery, and patients with long operation time, we should be alert to the risk of urinary sepsis after URSL.

Key words: Ureteroscopic lithotripsy, Urosepsis, Complication, Risk factors

Bing Yang, Dongliang Pan, Lianchao Jin, Zhe Zhou, Pengfei Gao, Ze Zhou, Zhihong Zhang, Ningchen Li. Risk factor for urosepsis after transurethral ureterorenoscopic holmium laser lithotripsy[J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(02): 107-111.

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URL: https://zhlcyszz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0785.2022.02.001

https://zhlcyszz.cma-cmc.com.cn/EN/Y2022/V16/I02/107

Figures/Tables 2

项目	非脓毒症患者（1086例）	脓毒症患者（21例）	t/χ²值	P值
年龄（岁， $x ¯$ ±s）	49.88±13.29	55.71±13.41	20.77	0.062
性别［例（%）］			0.095	0.828
男	554（52.46）	10（47.62）
女	532（48.99）	11（52.38）
BMI（kg/m²， $x ¯$ ±s）	23.13±2.80	24.33±2.87	1.945	0.049
糖尿病［例（%）］			0.622	0.473
有	327（30.11）	8（38.10）
无	759（69.89）	13（61.90）
结石大小（mm， $x ¯$ ±s）	11.04±4.29	13.14±4.82	2.224	0.026
结石分侧［例（%）］			0.256	0.648
单侧	1013（93.28）	19（90.48）
双侧	73（6.72）	2（9.52）
手术方式［例（%）］			5.134	0.023
单纯URSL	419（38.58）	3（14.29）
fURL	667（61.42）	18（85.71）
CT值（HU， $x ¯$ ±s）	759.06±190.24	844.28±191.23	2.024	0.056
术前梗阻性肾盂肾炎［例（%）］			43.13	0.001
有	136（12.88）	13（61.90）
无	950（87.48）	8（38.10）
术前尿细菌培养阳性［例（%）］			56.52	0.001
有	109（10.04）	13（61.90）
无	977（89.96）	8（38.10）
术前留置输尿管支架［例（%）］			0.305	0.650
有	373（43.35）	6（28.57）
无	713（65.65）	15（71.43）
手术时间（min， $x ¯$ ±s）	59.04±24.67	92.24±21.67	6.935	0.002
结石清除率［例（%）］			0.730	0.379
结石清除	904（83.24）	16（76.19）
结石残留	182（16.76）	5（23.81）

项目	非脓毒症患者（1086例）	脓毒症患者（21例）	t/χ²值	P值
年龄（岁， $x ¯$ ±s）	49.88±13.29	55.71±13.41	20.77	0.062
性别［例（%）］			0.095	0.828
男	554（52.46）	10（47.62）
女	532（48.99）	11（52.38）
BMI（kg/m²， $x ¯$ ±s）	23.13±2.80	24.33±2.87	1.945	0.049
糖尿病［例（%）］			0.622	0.473
有	327（30.11）	8（38.10）
无	759（69.89）	13（61.90）
结石大小（mm， $x ¯$ ±s）	11.04±4.29	13.14±4.82	2.224	0.026
结石分侧［例（%）］			0.256	0.648
单侧	1013（93.28）	19（90.48）
双侧	73（6.72）	2（9.52）
手术方式［例（%）］			5.134	0.023
单纯URSL	419（38.58）	3（14.29）
fURL	667（61.42）	18（85.71）
CT值（HU， $x ¯$ ±s）	759.06±190.24	844.28±191.23	2.024	0.056
术前梗阻性肾盂肾炎［例（%）］			43.13	0.001
有	136（12.88）	13（61.90）
无	950（87.48）	8（38.10）
术前尿细菌培养阳性［例（%）］			56.52	0.001
有	109（10.04）	13（61.90）
无	977（89.96）	8（38.10）
术前留置输尿管支架［例（%）］			0.305	0.650
有	373（43.35）	6（28.57）
无	713（65.65）	15（71.43）
手术时间（min， $x ¯$ ±s）	59.04±24.67	92.24±21.67	6.935	0.002
结石清除率［例（%）］			0.730	0.379
结石清除	904（83.24）	16（76.19）
结石残留	182（16.76）	5（23.81）

影响因素	β值	SE	Wald χ²值	OR值	95%CI	P值
BMI	-0.894	0.694	1.662	0.409	0.105~1.592	0.197
结石大小	-0.085	0.219	0.151	0.918	0.598~1.410	0.698
手术方式	1.498	0.776	3.731	4.473	0.978~20.457	0.053
手术时间	0.146	0.062	5.625	1.157	1.026~1.305	0.018
尿培养	1.665	0.675	6.085	5.287	1.408~19.857	0.014
肾盂肾炎	1.554	0.669	5.393	4.733	1.274~17.573	0.020

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