TY - JOUR
T1 - Risk Factors for a Complicated Postoperative Course in Flexible Ureteroscopy
AU - Ozimek, Tomasz
AU - Hochguertel, Laura
AU - Hupe, Marie C.
AU - Struck, Julian P.
AU - Wiessmeyer, Judith R.
AU - Gilbert, Nils
AU - Merseburger, Axel S.
AU - Kramer, Mario W.
N1 - Publisher Copyright:
© 2021 S. Karger AG, Basel.
PY - 2021/6/1
Y1 - 2021/6/1
N2 - Introduction: The goal was to determine risk factors for Clavien-Dindo (CD) grade 2 complications, with special focus on early postoperative systemic inflammatory response syndrome (SIRS), for flexible ureteroscopy (fURS). Materials and Methods: A retrospective monocentric statistical analysis relating to 32 factors was performed with the χ test, Mann-Whitney U tests, and multivariate logistic regression. Results: In total, 416 consecutive fURS performed between September 2013 and June 2017 were analyzed; 283 (68.03%) of these were for stone surgery and 133 (31.97%) for diagnostic purposes. In 43 cases (10.34%), CD2 occurred; 31 cases (72.09%) of these were SIRS. On multivariate logistic regression, positive preoperative urine culture and steep pyelographic and CT-based infundibulopelvic angle (IPA) have been confirmed as independent risk factors for both CD2 and SIRS. Greater maximal median stone diameter and female gender were significantly associated only with a higher CD ≥2 prevalence, but not with SIRS. The influence of ureteral access sheath (UAS) on CD ≥ 2 or SIRS occurrence could not be confirmed on multivariate analysis. Perioperative antibiotic prophylaxis for patients with negative urine culture showed no difference regarding SIRS prevalence. Conclusion: Steep CT-based IPA can be considered as a new radiologic predictor of complicated postoperative course and SIRS. The role of UAS as well as indications for perioperative antibiotic prophylaxis should be determined in prospective studies.
AB - Introduction: The goal was to determine risk factors for Clavien-Dindo (CD) grade 2 complications, with special focus on early postoperative systemic inflammatory response syndrome (SIRS), for flexible ureteroscopy (fURS). Materials and Methods: A retrospective monocentric statistical analysis relating to 32 factors was performed with the χ test, Mann-Whitney U tests, and multivariate logistic regression. Results: In total, 416 consecutive fURS performed between September 2013 and June 2017 were analyzed; 283 (68.03%) of these were for stone surgery and 133 (31.97%) for diagnostic purposes. In 43 cases (10.34%), CD2 occurred; 31 cases (72.09%) of these were SIRS. On multivariate logistic regression, positive preoperative urine culture and steep pyelographic and CT-based infundibulopelvic angle (IPA) have been confirmed as independent risk factors for both CD2 and SIRS. Greater maximal median stone diameter and female gender were significantly associated only with a higher CD ≥2 prevalence, but not with SIRS. The influence of ureteral access sheath (UAS) on CD ≥ 2 or SIRS occurrence could not be confirmed on multivariate analysis. Perioperative antibiotic prophylaxis for patients with negative urine culture showed no difference regarding SIRS prevalence. Conclusion: Steep CT-based IPA can be considered as a new radiologic predictor of complicated postoperative course and SIRS. The role of UAS as well as indications for perioperative antibiotic prophylaxis should be determined in prospective studies.
UR - http://www.scopus.com/inward/record.url?scp=85100889758&partnerID=8YFLogxK
UR - https://www.mendeley.com/catalogue/bd860944-1cf6-31df-996e-3ed23b4b1118/
U2 - 10.1159/000512892
DO - 10.1159/000512892
M3 - Journal articles
AN - SCOPUS:85100889758
SN - 0042-1138
VL - 105
SP - 611
EP - 618
JO - Urologia Internationalis
JF - Urologia Internationalis
IS - 7
ER -
