Outcomes of Elective Ureteroscopy for Ureteric Stones in Patients with Prior Urosepsis and Emergency Drainage: Prospective Study over 5 yr from a Tertiary Endourology Centre

Pietropaolo, Amelia; Hendry, Jane; Kyriakides, Rena; Geraghty, Robert; Jones, Patrick; Aboumarzouk, Omar; Somani, Bhaskar K.

doi:10.1016/j.euf.2018.09.001

Cited by 21 publications

(17 citation statements)

References 22 publications

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“…In patients with urosepsis due to obstructed ureteric stone, an immediate drainage via a nephrostomy or ureteric stent is needed, in addition to antibiotics and supportive care [37]. A delayed ureteroscopy and stone treatment in these cases lead to good clinical outcome [37].…”

Section: Discussionmentioning

confidence: 99%

“…Urgent decompression in obstructed calculus-related sepsis is warranted; otherwise, the mortality is doubled, and this drainage should be early (within 48 h) to reduce the hospital stay [39,40]. Although there is no consensus on the time duration between emergency drainage and elective ureteroscopy, it is generally agreed that this should be as soon as the patient has recovered from the initial sepsis and is stable to undergo the ureteroscopy [37].…”

Section: Discussionmentioning

confidence: 99%

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Predictors of Urinary Infections and Urosepsis After Ureteroscopy for Stone Disease: a Systematic Review from EAU Section of Urolithiasis (EULIS)

et al. 2020

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Purpose of Review To present the latest evidence related to the predictors of urinary tract infections (UTIs) and urosepsis after ureteroscopy (URS) for stone disease. Recent Findings Our review suggests that almost half of all post-URS complications are related to infectious complications although reported rates of urosepsis were low. The use of antibiotic prophylaxis, treatment of pre-operative UTI, and low procedural time seem to reduce this risk. However, the risk is higher in patients with higher Charlson comorbidity index, elderly patients, female gender, long duration of pre-procedural indwelling ureteric stents and patients with a neurogenic bladder and with high BMI. Summary Infectious complications following ureteroscopy can be a source of morbidity and potential mortality. Although majority of these are minor, efforts must be taken to minimise them especially in high-risk patients. This includes the use of prophylactic antibiotics, limiting stent dwell and procedural time, prompt identification and treatment of UTI and urosepsis, and careful planning in patients with large stone burden and multiple comorbidities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predictors of Urinary Infections and Urosepsis After Ureteroscopy for Stone Disease: a Systematic Review from EAU Section of Urolithiasis (EULIS)

et al. 2020

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“…An obstructing urinary calculus with a concomitant urinary traction infection is a common urological emergency with a reported incidence of 20.1 per 100,000 adults per year, [3] an ICU admission rate of 35%, [6] and a mortality of 0 to 2%. [1,5] While previous literature has demonstrated biochemical factors predictive of ICU admission, we believe that this is the first study to show that septic stone patients presenting with AKI (and hypothermia on univariate analysis) and requiring intubation were at an increased risk of mortality during their hospitalization.…”

Section: Discussionmentioning

confidence: 99%

“…[5] Following ICU admission, elective ureteroscopic lithotripsy for definitive treatment has been shown to be safe and efficacious, regardless of the method for emergency decompression that was initially used. [6] However, no study has compared factors of septic stone patients requiring ICU admission at presentation with their subsequent morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Predictors of mortality for patients admitted to the intensive care unit with obstructing septic stones

Mann¹,

Jain²,

Wong³

et al. 2021

CUAJ

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Introduction: Patients diagnosed with septic stone are at significant risk of morbidity and mortality should source control through drainage be delayed, and they are often admitted to intensive care units (ICU) for hemodynamic support. The purpose of this study was to determine patient factors that may predict mortality in patients admitted to ICU with septic stone, particularly whether rural patients at a greater distance from a tertiary care center were at greater risk of mortality given the inherent delay in intervention. Methods: The Manitoba Intensive Care Unit prospective registry began in 1999 and includes all patients admitted to ICU across Manitoba. Baseline characteristics, such as age, gender, vital signs, creatinine, Charlson comorbidity index (CCI), mortality outcomes, and location of residency were obtained for those admitted to ICU for septic stone. Association between death and clinical/demographic variable was performed with adjusted multivariable logistical regression analysis. Results: A total of 342 patients admitted to the ICU were analyzed with a mean age of 63.5±15.5 years. Baseline characteristics were similar between groups (p>0.05). On multivariable adjusted logistical regression, the presence of acute kidney injury (AKI) (p<0.001) and intubation (p<0.001) were associated with mortality. There was no difference in mortality attributable to location of residency, vital signs, or CCI. Conclusions: Among patients admitted to the ICU for septic stones in Manitoba, we demonstrate an association between AKI and intubation with mortality. Other factors, such as whether patients were from a rural region and baseline patient characteristics, were not predictive of mortality.

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“…Endoscopic upper urinary tract instrumentation is a common urological procedure that is often associated with prior ureteric stenting. While this does reduce the risk of ureteric injury and increase the success rate of the ureteroscopic procedure, 1,2 it does increase the risk of postoperative urosepsis compared with the non-stented patient. 3 Urosepsis post instrumentation of the upper urinary tract occurs in approximately 3-5% of patients 4,5 and is a concern for all urologists.…”

Section: Introductionmentioning

confidence: 99%

The utility of preoperative and intraoperative cultures for guiding urosepsis empirical treatment

Wood

Habashy

Mayne

et al. 2019

Journal of Clinical Urology

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Objective: Endoscopic upper urinary tract instrumentation is a common urological procedure; often associated with prior ureteric stenting and postoperative urosepsis. This study aimed to explore the clinical utility of preoperative urine and intraoperative urine and ureteric stent cultures in the management of urosepsis post upper urinary tract instrumentation. Methods: Prospective study involving pre-stented patients whose upper urinary tract was instrumented at a single centre between 2017 and 2018. Five cultures were collected per patient. Patients were tracked for development of postoperative urosepsis. Results: The study included 227 patients, with a 5.7% postoperative urosepsis rate. Risk of urosepsis was significantly associated with female gender, steroid use and having a colonized preoperative urine culture, intraoperative bladder urine or stent-end culture, or kidney urine culture. Patients with a colonized intraoperative bladder urine were 11 times more likely to develop urosepsis and were colonized with the same organism isolated from urosepsis cultures for 50% of cases. Conclusions: To our knowledge this is the largest cohort study which analyses five different urinary tract cultures and the relationship with postoperative urosepsis. A positive intraoperative bladder urine culture is an independent predictor of postoperative urosepsis development and causative organism, which could guide antibiotic management for these patients. Level of Evidence 3-b

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Outcomes of Elective Ureteroscopy for Ureteric Stones in Patients with Prior Urosepsis and Emergency Drainage: Prospective Study over 5 yr from a Tertiary Endourology Centre

Cited by 21 publications

References 22 publications

Predictors of Urinary Infections and Urosepsis After Ureteroscopy for Stone Disease: a Systematic Review from EAU Section of Urolithiasis (EULIS)

Predictors of Urinary Infections and Urosepsis After Ureteroscopy for Stone Disease: a Systematic Review from EAU Section of Urolithiasis (EULIS)

Predictors of mortality for patients admitted to the intensive care unit with obstructing septic stones

The utility of preoperative and intraoperative cultures for guiding urosepsis empirical treatment

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