Risk of Sepsis in Retrograde Intrarenal Surgery: A Systematic Review of the Literature

Corrales, Mariela; Sierra, Alba; Doizi, Steeve; Traxer, Olivier

doi:10.1016/j.euros.2022.08.008

Cited by 46 publications

(29 citation statements)

References 50 publications

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“…Disposable scopes have been favored over reusables to minimize time, costs of sterilization, and proposed as a better alternative to minimize infective complications if reusables are not sterilized well. 9,32 Our study does not support this finding as similar profiles of infective complications were noted in both groups. Hence, we would suggest advocating or advertising the use of a disposable scope to minimize infective complications, and if sterilization protocols are safely followed, there is no reason that reusables should be considered inferior.…”

Section: Discussioncontrasting

confidence: 74%

“…This was also reported by Corrales et al in their meta-analysis and several other studies have identified older patient age, patient comorbidities, renal abnormalities, altered kidney function, pregnancy, history of UTI, infectious stone disease, inadequate antibiotic coverage, stone size, lower pole stones and operative times, and intrarenal pressures (IRP), among several other factors as independent contributing factors for septic complications after RIRS. 27–32 However, they did not recommend using a disposable scope to actually minimize the risk of infective complications and hence it remains debatable if disposable scope is indeed an independent risk factor for infective complications. In the overall cohort, an UAS was used in 99.62% of patients (Table 2), which might have contributed to minimizing the risk of high IRP as a significant attributing factor for post-op major sepsis.…”

Section: Discussionmentioning

confidence: 99%

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RIRS with disposable or reusable scopes: does it make a difference? Results from the multicenter FLEXOR study

Gauhar

Chai

Chew

et al. 2023

Therapeutic Advances in Urology

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Introduction: With several single-use ureteroscopes now available, our aim was to analyze and compare data obtained globally from high-volume centers using both disposable and reusable flexible ureteroscopes and see if indeed in real-world practice either scope has a distinct advantage. Methods: Retrospective analysis was performed on the FLEXOR registry, which was created as a TOWER group (Team of Worldwide Endourological Researchers, research wing of the Endourological Society) endeavor. Patients who underwent retrograde intrarenal surgery (RIRS) for renal stones from January 2018 to August 2021 were enrolled from 20 centers globally. A total of 6663 patients whose data were available for analysis were divided into Group 1 (Reusable scopes, 4808 patients) versus Group 2 (Disposable scopes, 1855 patients). Results: The age and gender distribution were similar in both groups. The mean stone size was 11.8 mm and 9.6 mm in Groups 2 and 1, respectively ( p < 0.001). Group 2 had more patients with >2 cm stones, lower pole stones and of higher Hounsfield unit. Thulium fiber laser (TFL) was used more in Group 2 ( p < 0.001). Patients in Group 2 had a slightly higher stone-free rate (SFR) (78.22%) and a lower number of residual fragments (RFs) compared with Group 1 ( p < 0.001). The need for further treatments for RF and overall complications was comparable between groups. On multivariate analysis, overall complications were more likely to occur in elderly patients, larger stone size, lower pole stones, and were also more when using disposable scopes with longer operative time. RFs were significantly higher ( p < 0.001) for lower pole, larger, harder, multiple stones and in elderly. Conclusion: Our real-world practice observations suggest that urologists choose disposable scopes for bigger, lower pole, and harder stones, and it does indeed help in improving the single-stage SFR if used correctly, with the appropriate lasers and lasing techniques in expert hands.

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Section: Discussioncontrasting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

RIRS with disposable or reusable scopes: does it make a difference? Results from the multicenter FLEXOR study

Gauhar

Chai

Chew

et al. 2023

Therapeutic Advances in Urology

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“…Therefore, it is crucial to have a preoperative microbiological test and keep the surgery time for the FURS operation between 90 and 120 min. Furthermore, there is evidence that high irrigation pressure is a risk factor for urosepsis in RIRS [ 24 ]. Unfortunately, we did not have the means to measure the intrarenal pressure, but we tried to reduce it by using a ureteral access sheath [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison between Retrograde Flexible Ureteroscopy and Percutaneous Nephrolithotomy for the Treatment of Renal Stones of 2–4 cm

et al. 2023

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Background and objectives: Renal stones are widespread, with a lifetime prevalence of 10% in adults. Flexible ureteroscopy enables urologists to treat lower calyx stones or even complex renal stones through the natural orifice and achieve an acceptable stone-free rate. Hence, we analyzed the effectiveness and safety of FURS versus PCNL in treating renal stones between 20 and 40 mm in diameter. Materials and methods: We retrospectively analyzed 250 consecutive patients with large renal solitary stones (stone burden between 2 and 4 cm) from 1 January 2019 to 31 December 2020. The patients were divided into two groups: group 1 (125 patients), in which the patients were treated by a retrograde flexible ureteroscopic approach, and group 2 (125 patients), in which we used percutaneous nephrolithotomy. Stone characteristics and anatomical data were observed based on the computed tomography (CT) and/or KUB (Kidney-ureter-Bladder) radiography imaging archive. Results: The mean stone burden was 26.38 ± 4.453 mm in group 1 and 29.44 ± 4.817 mm in group 2. The stone-free rate after the first ureteroscopy was higher for the PNL(percutaneous nephrolithotomy) group (90.4%) than the F-URS group (68%). After two sessions of ureteroscopy, the SFR was 88.8% in the first group, and after three procedures, the SFR rose to 95.2%. The overall complication rate was higher in group 1 than in group 2 (18.4% vs. 16.8%), but without statistical relevance (p > 0.5). Furthermore, we encountered more grade III and IV complications in the PNL group (8.8% vs. 4.8%, p < 0.05). Conclusion: Flexible ureteroscopy proves to be efficient in treating renal stones over 2 cm. However, the patients must be informed that more than one procedure might be necessary to overcome the entire stone burden.

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“…Studies have shown that women are more than men in patients with urinary sepsis, and perimenopausal women are more likely to develop urinary sepsis than women of other ages. [23][24][25] The female urethra is shorter than the male urethra. At the same time, the external orifice of the urethra is adjacent to the rectum and vagina, and the mucosa is more vulnerable to the influence of venous circulation, so female is prone to infection.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Characteristics, Pathogens and Drug Resistance of Urinary Tract Infection Associated with Long-Term Indwelling Double-J Stent

Li¹,

Jiang²,

Luo³

et al. 2023

IDR

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Objective To investigate the characteristics, pathogens and drug resistance of urinary tract infection (UTI) associated with long-term indwelling double-J stent. Methods The clinical data of 102 patients with urinary tract infection associated with long-term indwelling double-J stent in University-Town Hospital of Chongqing Medical University and Chongqing Traditional Chinese Medicine Hospital from September 2010 to July 2022 were collected retrospectively, and the difference between etiological characteristics were analyzed. Urine and double-J stent samples of patients were collected for pathogen identification and drug sensitivity test. Results A total of 102 patients, 39 (38.23%) males and 63 (61.77%) females, aged 24–72 years, with a median age of 48 years, were included in this study. Urinary calculi (40.20%) and ureteral stricture (24.50%) were the main causes of urinary tract infection associated with long-term indwelling double-J stent. Among the patients with urinary tract infection caused by double-J stent, female patients were higher than male patients (61.77% vs 38.23%). In terms of positive rate of pathogenic bacteria culture, the rate of double-J stent was higher than that of urine (67.65% vs 35.29%). The main pathogenic bacteria in urine were Escherichia coli (30.55%) of Gram negative bacteria, while the main pathogenic bacteria in double-J stent were enterococcus faecalis (27.53%) of Gram positive bacteria. The resistance rate of Gram positive bacteria in double-J stent to vancomycin, ciprofloxacin, meropenem and piperacillin/tazobactam was significantly higher than that in urine ( P <0.05). The resistance rate of Gram negative bacteria in double-J stent to imipenem, cefepime, piperacillin/tazobactam, meropenem and cefoperazone/sulbactam was significantly higher than that in urine ( P <0.05). Conclusion Double-J stent associated urinary tract infection is more common in women than in men. Escherichia coli and Enterococcus faecalis are the main pathogens, and the pathogens show strong drug resistance.

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Risk of Sepsis in Retrograde Intrarenal Surgery: A Systematic Review of the Literature

Cited by 46 publications

References 50 publications

RIRS with disposable or reusable scopes: does it make a difference? Results from the multicenter FLEXOR study

RIRS with disposable or reusable scopes: does it make a difference? Results from the multicenter FLEXOR study

Comparison between Retrograde Flexible Ureteroscopy and Percutaneous Nephrolithotomy for the Treatment of Renal Stones of 2–4 cm

Analysis of Characteristics, Pathogens and Drug Resistance of Urinary Tract Infection Associated with Long-Term Indwelling Double-J Stent

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