Risk Factors of Infectious Complications after Ureteroscopy: A Systematic Review and Meta-Analysis Based on Adjusted Effect Estimate

Ma, Yucheng; Jian, Zhongyu; Chi, Yuan; Li, Hong; Wang, Kun‐Jie

doi:10.1089/sur.2020.013

Cited by 14 publications

(17 citation statements)

References 26 publications

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“…The current systematic review is unique in that we identified risk factors for urosepsis after URS, whereas others have reported risk factors for generalized infectious complications that included less severe complications such as isolated fever or UTI. 3,4 However, the risk factors for urosepsis identified in this review are similar to those previously identified for generalized infectious complications. Sun and colleagues 4 reported that a positive preoperative urine culture was the strongest risk factor (odds ratio = 2.95, p < 0.01) for generalized infectious complications after URS, with female sex, diabetes mellitus, preoperative stent placement, and longer procedure time also demonstrating statistical significance.…”

Section: Discussionsupporting

confidence: 73%

“…Because of the considerable clinical and economic burden of urosepsis, identification of risk factors for this complication after URS would be particularly informative to patients, physicians, and health care policy makers. Although others have reported risk factors for generalized infectious complications, 3,4 this is the first systematic review with meta-analysis to specifically investigate risk factors for postoperative urosepsis after URS. The overall risk of postoperative urosepsis was 5.0% in this review.…”

Section: Discussionmentioning

confidence: 99%

“…Previous meta-analyses have identified risk factors for infectious complications after URS for stone disease. 3,4 However, the definition of infectious complications in these reviews included a spectrum of diagnoses ranging from isolated fever or urinary tract infection (UTI) to urosepsis. Since patient prognosis and therapeutic strategies differ by diagnosis where urosepsis confers the greatest patient risk with potential for extended hospitalization, unplanned intensive care admission, or death, 5 identification of risk factors specifically for postoperative urosepsis may assist with risk stratification before URS.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Urosepsis After Ureteroscopy for Stone Disease: A Systematic Review with Meta-Analysis

Bhojani

Miller²,

Cutone

et al. 2021

Journal of Endourology

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Introduction: Urosepsis is a serious potential complication of ureteroscopic procedures for stone disease, yet the risk factors for this complication are not well characterized. The purpose of this systematic review with meta-analysis was to identify potential risk factors for urosepsis after ureteroscopy (URS) for stone disease. Materials and Methods: We performed systematic searches of Medline, Embase, and the Cochrane Central Register of Controlled Trials for studies reporting at least one prospectively defined risk factor for urosepsis after URS. Studies that only reported rates of isolated fever, urinary tract infection (UTI), or pooled infectious complications were excluded. The risk factors evaluated in this review were age, sex, body mass index, diabetes mellitus, ischemic heart disease, recent UTI, pyuria, hydronephrosis, stone history, stone size, preoperative stent placement, preoperative positive urine culture, and procedure time. A random effects meta-analysis model with inverse variance weighting was used where the statistic of interest was the odds ratio for dichotomous variables and the mean difference for continuous outcomes. Results: In 13 studies (5 prospective) with 5597 patients, the pooled incidence of postoperative urosepsis was 5.0% (95% confidence interval: 2.4-8.2). Six risk factors were statistically associated with increased postoperative urosepsis risk-preoperative stent placement (odds ratio = 3.94, p < 0.001, 6 studies), positive preoperative urine culture (odds ratio = 3.56, p < 0.001, 6 studies), ischemic heart disease (odds ratio = 2.49, p = 0.002, 2 studies), older age (mean difference = 2.7 years, p = 0.002, 6 studies), longer procedure time (mean difference = 9 minutes, p = 0.02, 1 study), and diabetes mellitus (odds ratio = 2.04, p = 0.04, 6 studies). Conclusions: Current evidence suggests that among patients undergoing URS for treatment of stone disease, the risk of postoperative urosepsis was 5.0%. Older age, diabetes mellitus, ischemic heart disease, preoperative stent placement, a positive urine culture, and longer procedure time were associated with increased postoperative urosepsis risk. These results will assist urologists with preoperative risk stratification before ureteroscopic procedures.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Risk Factors for Urosepsis After Ureteroscopy for Stone Disease: A Systematic Review with Meta-Analysis

Bhojani

Miller²,

Cutone

et al. 2021

Journal of Endourology

View full text Add to dashboard Cite

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“…In their study, they also added preoperative polymicrobial urine culture and increased operative time as predictors of postoperative UTI. Our conclusions are also supported by the recent meta-analysis of Ma et al [15]. In contrast, the study of Baseskioglu et al, [16] recognized preoperative infection history, comorbidity score and residual fragments as signi cant predictors of UTI after fURS while the relevant risk factors in the study of Ozgor et al, [17] were longer operation time, presence of renal abnormality and age ≤ 40 years.…”

Section: Discussionsupporting

confidence: 81%

Effect of standard antibiotic prophylaxis versus enhanced prophylactic measures on rate of urinary tract infection after flexible ureteroscopy: A randomized clinical study

El-Agamy

Elhelaly

Abouelgreed

et al. 2021

Preprint

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BackgroundPrevention of urinary tract infections (UTIs) after flexible ureteroscopy (fURS) remains controversial. The present study aimed to compare the rate of post-procedural UTI in patients subjected to the standard antibiotic prophylaxis alone versus enhanced prophylactic measures.Methodsfrom August 2018 to September 2020, a total of 100 patients subjected to fURS for management of ureteral and/or renal stones were included in this study. Patients were equally and randomly divided to two treatment groups using randomly computer-generated allocation tables and concealed envelope technique. Treatment groups included standard antibiotic prophylaxis group and enhanced prophylaxis group. Patients in the standard antibiotic prophylaxis group IV, fluoroquinolone 1 hour preoperatively and oral antibiotics were used for 24h postoperatively. In the enhanced prophylaxis group, patients had urine culture 10 days before the procedure. In addition to the antibiotic prophylaxis, hydrophilic-coated ureteral access sheaths were systematically used.ResultsComparison between the baseline and operative characteristics of the studied groups revealed no statistically significant differences. Postoperatively, 8 patients (16.0 %) in the standard prophylaxis group were diagnosed with UTI in comparison to 2 patients (4.0 %) in the enhanced prophylaxis group expressing a statistically significant difference (p = 0.046). Using binary logistic regression analysis, female patients’ sex [OR (95% CI): 0.09 (0.018–0.46), operative time [OR (95%CI): 0.97 (0.94–0.99)] were significant predictors of postoperative UTI in univariate analysis. However, only female sex remained significant in multivariate analysis [OR (95% CI): 0.09 (0.017–0.49)].ConclusionsUrinary tract infection after fURS can be significantly reduced by using the suggested enhanced prophylactic approach.

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“…In a metaanalysis, in which 12,357 patients were evaluated, female gender, pre-operative DJS insertion, diabetes mellitus, positive urine culture results before surgery, and operation duration were reported as risk factors for the development of infection after ureteroscopy. 29 In another study, the predicting factors of postoperative UTI occurrence were reported as comorbidity, UTI history, and presence of residual stone. 30 These factors were not statistically different between the infective and control groups in the current study.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Aims: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. Methods: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.Results: A total of 916 f-URS cases that had all required data were analysed. Sixtyeight 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 2 weeks, 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 >14 days. ROC curve analysis provided a 14.5-day period as a cut-off value of Δ-day for postoperative UTI. Conclusions: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 >14 days, 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.

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Risk Factors of Infectious Complications after Ureteroscopy: A Systematic Review and Meta-Analysis Based on Adjusted Effect Estimate

Cited by 14 publications

References 26 publications

Risk Factors for Urosepsis After Ureteroscopy for Stone Disease: A Systematic Review with Meta-Analysis

Risk Factors for Urosepsis After Ureteroscopy for Stone Disease: A Systematic Review with Meta-Analysis

Effect of standard antibiotic prophylaxis versus enhanced prophylactic measures on rate of urinary tract infection after flexible ureteroscopy: A randomized clinical study

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

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