The Role of Antegrade Irrigation via Percutaneous Nephrostomy on Surgical Outcomes in Semirigid Ureteroscopy among Patients with Upper Ureteral Stones

Abstract

Objective. We aimed to investigate the role of antegrade irrigation via percutaneous nephrostomy on surgical outcomes in retrograde ureteroscopy in patients with upper ureter stones. Materials and Methods. In this retrospective study, we analyzed 134 patients who underwent retrograde semirigid ureteroscopy for upper ureter stones between August 2012 and December 2017. Patients were divided into two groups: retrograde irrigation group (conventional URS) and antegrade irrigation group (using percutaneous nephrostomy). Operation time, postoperative hospital stay, complications, and stone-free rate were measured for each patient after ureteroscopy. Results. The mean age in the retrograde irrigation and antegrade irrigation groups was 53.3 and 60.7 years, respectively (p=0.007). The operation time was 60.8 min vs. 43.0 min (p=0.002), and stone-free rate was 82.0 % vs. 95.5 % (p=0.033). Stone size, laterality, the proportion of male patients, and urinary tract infection prevalence were comparable between the groups. In the subgroup analysis of stone size >10 mm, the antegrade irrigation group had a shorter operation time and a higher stone-free rate. For stone size of 5–10 mm, operation time in the antegrade irrigation group was shorter and the stone-free rate between the two groups was comparable. Conclusion. Antegrade irrigation via percutaneous nephrostomy during ureteroscopy has a higher stone-free rate with a shorter operation time without an increased urinary tract infection risk. Therefore, if percutaneous nephrostomy is necessary before ureteroscopy, antegrade irrigation of external fluid via percutaneous nephrostomy is strongly recommended.

Predictive Risk Factors of Urinary Tract Infection Following Semirigid Ureteroscopic Lithotripsy

“…Georgescu et al (23) reported that prolongation of the operation time also increased the overall complication rate. In another study of 134 patients, it was reported that prolonged operation time increased UTI after semirigid URS (24) . Similarly, univariate analysis of our study indicated that the duration of URS was a significant risk factor for occurrence of UTI in the postoperative period.…”

“…In our study, success rate of URS in the general population was 88 percent. Patients with residual fragments represent an important risk group for postoperative UTI (12,24,26,27) . Castro et al (12) reported that the success rate increased to 94.2%, especially in distal ureteral stones.…”

“…Presence of prior surgery, n (%) UTI history, n (%) Preoperative DJS placement, n (%) Δ-day Δ-day subgroup Δ-day 0-14 Δ-day [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Operation time, min Postoperative DJS placement, n (%) Hospitalization, day Presence of residual stone, n (%) (Table 3).…”

Bilateral emphysematous pyelonephritis

“…Furthermore, it is possible that the act of irrigation alone mechanically results in reduction of burden of disease. A study performed evaluating surgical complications due to stone retropulsion in upper ureteral stones revealed better outcomes when anterograde irrigation via percutaneous nephrostomy tube was delivered rather than retrograde irrigation via the bladder, suggesting that the irrigation alone may play a large role to decrease infective burden in this case [ 11 ]. Bladder irrigations with gentamicin were used successfully in preventing recurrence of cystitis in neurogenic bladder patients without systemic absorption [ 12 ].…”

‘Boxing in the corner’: A modified retrograde approach for the management of proximal ureteric stones of 1–2 cm

“…Meanwhile, these devices may not be able to pass above the stone due to stone impaction or they may fail to completely secure the dilated ureter above the stone giving space for some fragments to escape between the device and the ureteric wall. Modifications for treating proximal ureteric stones have been reported in many clinical trials achieving superior outcomes and improving the SFR (Table 4 [10][11][12][13][14][15][16][17]).…”