Postoperative Care of the Ureteroscopy Patient

Sabler, Itay M.; Katafygiotis, I.; Duvdevani, Mordechai

doi:10.1007/978-3-030-26649-3_11

Cited by 3 publications

(3 citation statements)

References 29 publications

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“…Switching antibiotic therapy from empiric to therapy based sensitivities should be done as soon as the information becomes available ( 22 ). In addition to prompt initiation of antimicrobial therapy and infectious disease consultation, the diagnosis of urosepsis following RIRS should prompt an early escalation of care to an ICU setting ( 74 ). Patients should receive proper hemodynamic and respiratory support if their clinical condition necessitates it ( 69 ).…”

Section: Post-operative Considerationsmentioning

confidence: 99%

“…The current guidelines state that there is no evidence to continue antibiotic therapy after 24 h in the absence of other factors ( 14 ). However, some centers continue antibiotic therapy anywhere from 3 to 5 days postoperatively even in patients with negative cultures ( 74 ). Given the rise in MDR bacteria, the use of postoperative antibiotics in patients without risk factors or evidence of postoperative infection should be limited.…”

Section: Post-operative Considerationsmentioning

confidence: 99%

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Prevention and Management of Infectious Complications of Retrograde Intrarenal Surgery

et al. 2021

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Kidney stone disease (KSD) is a commonly encountered ailment in urologic practice. Urinary tract infection (UTI) is commonly associated with KSD, both as an etiology (e.g., struvite and carbonate apatite stones), and as a complication (i.e., obstructive pyelonephritis and post-operative UTI). Indeed, a significant portion of the economic burden of KSD is skewed toward stones associated with infection. UTI is the most common post-operative complication related to stone intervention with progression to urosepsis as a rare but serious consequence. Risk for infection is influenced by a variety of factors including co-morbid conditions, anatomic abnormalities, prior surgical procedures, and local anti-microbial susceptibility. Understanding these risks and the proper steps to mitigate them is an essential component in reducing post-operative morbidity and mortality. Retrograde intrarenal surgery is routinely used for the treatment of KSD. The objective of this review article is to examine the current literature and guidelines for the prevention and management of stone-related infectious complications associated with retrograde intrarenal surgery. Special attention will be given to the incidence, etiology, and antibiotic prophylaxis choice in the management of stone-related infections. Intraoperative risk mitigation techniques will be discussed in conjunction with the management of post-operative infections. Antibiotic stewardship and the potential benefits of reduced empiric antibiotic treatment will also be discussed.

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Section: Post-operative Considerationsmentioning

confidence: 99%

Section: Post-operative Considerationsmentioning

confidence: 99%

Prevention and Management of Infectious Complications of Retrograde Intrarenal Surgery

et al. 2021

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“…9 Attempts have been made to identify patterns among the predisposing factors of patients, and recommendations have been made to reduce the risk of occurrence. 9,10 The discussion will center on the facts regarding perirenal hematoma following ureteroscopy.…”

Section: Introductionmentioning

confidence: 99%

Perirenal Hematoma After Ureteroscopy : A Systematic Review

Rachmadhyan¹

2023

JARMHS

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The global incidence of urolithiasis is 14%, and the burden of urological consultants has increased by 20% over the past seven years, according to current trends. As a consequence, stone disease is becoming a burden on our health care system. However, advancements in apparatus and technology over the past two decades have made it possible for endourologists to perform increasingly complex treatments for the management of stones. Endourologists who treat ureteral or renal calculi are required to be aware of PRH risk factors. PRH occurred more frequently among patients with a low BMI. Patients with a low BMI had less body fat and perirenal fat than those with a higher BMI. After an injury, perirenal fat cushions the kidney to prevent cortical overstretching caused by an increase in renal pelvis irrigation pressure. PRH is produced in kidneys with minimal perirenal adipose. Two of the four patients with PRH had a low BMI. Underweight can be a sign of malnutrition, which can impair the structure of the kidneys. The timing of surgery is uncertain. PRH caused by FURSL may be treated as a kidney injury. If the patient has loin or flank pain after FURSL, the surgeon should examine the serum hemoglobin and perform abdominal sonography or a CT scan to detect PRH. Hematomas with mass effect were evacuated percutaneously when they were large. Percutaneous drainage may delay the progression of a hematoma in stable patients, although it may cause severe discomfort or renal compression. Angiograms should be used to treat renal bleeding if the serum hemoglobin continues to decline. If conservative or angiographic therapy fails to control bleeding, immediate open surgery must be performed. Cases of PRH are extremely uncommon, with percentages ranging from 0.1 to 8.9%. Despite this, this condition needs to be monitored closely because it has the potential to compromise the patient's health in a negative way.

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