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

CONTEXT: Nowadays, urolithiasis has become a highly prevalent disease. Recent studies indicate that retrograde intrarenal surgery (RIRS) is becoming more popular among surgical treatments due to the preference of patients and providers. This minimally invasive procedure results in high stone-free rates and relatively low morbidity; however, complications resulting from infection can still occur, including acute urinary tract infection, systemic inflammatory response syndrome, and sepsis. OBJECTIVE: To identify the independent risk factors for sepsis following RIRS, as well as general risk factors that may contribute to this life-threatening complication in the pre- and intraoperative periods. EVIDENCE ACQUISITION: A literature review was conducted in April 2020 using the Medline, Scopus, and Cochrane databases. We searched the references of included papers. EVIDENCE SYNTHESIS: We screened 2306 manuscripts and selected 13 for inclusion. The sepsis rate ranged from 0.5% to 11.1%, and the septic shock rate ranged from 0.3% to 4.6%. All selected studies mentioned risks for sepsis and/or infective complications (including sepsis), but only four of them addressed independent risks for urosepsis. These independent risk factors were stone size, high irrigation pressure, prolonged stent dwelling time (>30 d), sepsis as an indication for stent insertion, female gender, positive intraoperative bladder urine culture, longer surgical time, and diabetes mellitus. CONCLUSIONS: RIRS is associated with a low sepsis rate, according to the latest evidence. However, given that this is a serious life-threatening complication, knowing its potential risk factors is extremely important. PATIENT SUMMARY: In this report, we looked at the outcome of sepsis after planned retrograde intrarenal surgery for stone disease in patients with and without comorbidities. This information may be useful for colleagues in their daily practice.