Risk Factors for a Complicated Postoperative Course in Flexible Ureteroscopy

Tomasz Ozimek, Laura Hochguertel, Marie C. Hupe, Julian P. Struck, Judith R. Wiessmeyer, Nils Gilbert, Axel S. Merseburger, Mario W. Kramer*

*Corresponding author for this work


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.

Original languageEnglish
JournalUrologia Internationalis
Issue number7
Pages (from-to)611-618
Number of pages8
Publication statusPublished - 01.06.2021

Research Areas and Centers

  • Research Area: Luebeck Integrated Oncology Network (LION)


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