Cargando…
Understanding the Role of Ureteral Access Sheath in Preventing Post-Operative Infectious Complications in Stone Patients Treated with Ureteroscopy and Ho:YAG Laser Lithotripsy: Results from a Tertiary Care Referral Center
Introduction and objectives: The use of ureteral access sheaths (UAS) limits the irrigation-induced increase in intrarenal pressure during ureteroscopy (URS). We investigated the relationship between UAS and rates of postoperative infectious complications in stone patients treated with URS. Material...
Autores principales: | , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9963298/ https://www.ncbi.nlm.nih.gov/pubmed/36835992 http://dx.doi.org/10.3390/jcm12041457 |
_version_ | 1784896218176946176 |
---|---|
author | Villa, Luca Dioni, Pietro Candela, Luigi Ventimiglia, Eugenio De Angelis, Mario Corsini, Christian Robesti, Daniele Fantin, Margherita D’Arma, Alessia Proietti, Silvia Giusti, Guido Kartalas Goumas, Ioannis Briganti, Alberto Montorsi, Francesco Salonia, Andrea |
author_facet | Villa, Luca Dioni, Pietro Candela, Luigi Ventimiglia, Eugenio De Angelis, Mario Corsini, Christian Robesti, Daniele Fantin, Margherita D’Arma, Alessia Proietti, Silvia Giusti, Guido Kartalas Goumas, Ioannis Briganti, Alberto Montorsi, Francesco Salonia, Andrea |
author_sort | Villa, Luca |
collection | PubMed |
description | Introduction and objectives: The use of ureteral access sheaths (UAS) limits the irrigation-induced increase in intrarenal pressure during ureteroscopy (URS). We investigated the relationship between UAS and rates of postoperative infectious complications in stone patients treated with URS. Materials and methods: Data from 369 stone patients treated with URS from September 2016 to December 2021 at a single institution were analyzed. UAS (10/12 Fr) placement was attempted in case of intrarenal surgery. The chi-square test was used to assess the relationship between the use of UAS and fever, sepsis, and septic shock. Univariable and multivariable logistic regression analyses tested the association of patients’ characteristics and operative data and the rate of postoperative infectious complications. Results: Full data collection of 451 URS procedures was available. Overall, UAS was used in 220 (48.8%) procedures. As for postoperative infectious sequalae, we recorded fever (n = 52; 11.5%), sepsis (n = 10; 2.2%), and septic shock (n = 6; 1.3%). Of those, UAS was not used in 29 (55.8%), 7 (70%), and 5 (83.3%) cases, respectively (all p > 0.05). At multivariable logistic regression analysis, performing URS without UAS was not associated with the risk of having fever and sepsis, but it increased the risk of septic shock (OR = 14.6; 95% CI = 1.08–197.1). Moreover, age-adjusted CCI score (for fever-OR = 1.23; 95% CI = 1.07–1.42, sepsis-OR = 1.47; 95% CI = 1.09–1.99, and septic shock-OR = 1.61; 95% CI = 1.08–2.42, respectively), history of fever secondary to stones (for fever-OR = 2.23; 95% CI = 1.02–4.90) and preoperative positive urine culture (for sepsis-OR = 4.87; 95% CI = 1.12–21.25) did emerge as further associated risk factors. Conclusions: The use of UAS emerged to prevent the onset of septic shock in patients treated with URS, with no clear benefit in terms of fever and sepsis. Further studies may help clarify whether the reduction in fluid reabsorption load mediated by UAS is protective against life-threatening conditions in case of infectious complications. The patients’ baseline characteristics remain the main predictors of infectious sequelae in a clinical setting. |
format | Online Article Text |
id | pubmed-9963298 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-99632982023-02-26 Understanding the Role of Ureteral Access Sheath in Preventing Post-Operative Infectious Complications in Stone Patients Treated with Ureteroscopy and Ho:YAG Laser Lithotripsy: Results from a Tertiary Care Referral Center Villa, Luca Dioni, Pietro Candela, Luigi Ventimiglia, Eugenio De Angelis, Mario Corsini, Christian Robesti, Daniele Fantin, Margherita D’Arma, Alessia Proietti, Silvia Giusti, Guido Kartalas Goumas, Ioannis Briganti, Alberto Montorsi, Francesco Salonia, Andrea J Clin Med Article Introduction and objectives: The use of ureteral access sheaths (UAS) limits the irrigation-induced increase in intrarenal pressure during ureteroscopy (URS). We investigated the relationship between UAS and rates of postoperative infectious complications in stone patients treated with URS. Materials and methods: Data from 369 stone patients treated with URS from September 2016 to December 2021 at a single institution were analyzed. UAS (10/12 Fr) placement was attempted in case of intrarenal surgery. The chi-square test was used to assess the relationship between the use of UAS and fever, sepsis, and septic shock. Univariable and multivariable logistic regression analyses tested the association of patients’ characteristics and operative data and the rate of postoperative infectious complications. Results: Full data collection of 451 URS procedures was available. Overall, UAS was used in 220 (48.8%) procedures. As for postoperative infectious sequalae, we recorded fever (n = 52; 11.5%), sepsis (n = 10; 2.2%), and septic shock (n = 6; 1.3%). Of those, UAS was not used in 29 (55.8%), 7 (70%), and 5 (83.3%) cases, respectively (all p > 0.05). At multivariable logistic regression analysis, performing URS without UAS was not associated with the risk of having fever and sepsis, but it increased the risk of septic shock (OR = 14.6; 95% CI = 1.08–197.1). Moreover, age-adjusted CCI score (for fever-OR = 1.23; 95% CI = 1.07–1.42, sepsis-OR = 1.47; 95% CI = 1.09–1.99, and septic shock-OR = 1.61; 95% CI = 1.08–2.42, respectively), history of fever secondary to stones (for fever-OR = 2.23; 95% CI = 1.02–4.90) and preoperative positive urine culture (for sepsis-OR = 4.87; 95% CI = 1.12–21.25) did emerge as further associated risk factors. Conclusions: The use of UAS emerged to prevent the onset of septic shock in patients treated with URS, with no clear benefit in terms of fever and sepsis. Further studies may help clarify whether the reduction in fluid reabsorption load mediated by UAS is protective against life-threatening conditions in case of infectious complications. The patients’ baseline characteristics remain the main predictors of infectious sequelae in a clinical setting. MDPI 2023-02-12 /pmc/articles/PMC9963298/ /pubmed/36835992 http://dx.doi.org/10.3390/jcm12041457 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Villa, Luca Dioni, Pietro Candela, Luigi Ventimiglia, Eugenio De Angelis, Mario Corsini, Christian Robesti, Daniele Fantin, Margherita D’Arma, Alessia Proietti, Silvia Giusti, Guido Kartalas Goumas, Ioannis Briganti, Alberto Montorsi, Francesco Salonia, Andrea Understanding the Role of Ureteral Access Sheath in Preventing Post-Operative Infectious Complications in Stone Patients Treated with Ureteroscopy and Ho:YAG Laser Lithotripsy: Results from a Tertiary Care Referral Center |
title | Understanding the Role of Ureteral Access Sheath in Preventing Post-Operative Infectious Complications in Stone Patients Treated with Ureteroscopy and Ho:YAG Laser Lithotripsy: Results from a Tertiary Care Referral Center |
title_full | Understanding the Role of Ureteral Access Sheath in Preventing Post-Operative Infectious Complications in Stone Patients Treated with Ureteroscopy and Ho:YAG Laser Lithotripsy: Results from a Tertiary Care Referral Center |
title_fullStr | Understanding the Role of Ureteral Access Sheath in Preventing Post-Operative Infectious Complications in Stone Patients Treated with Ureteroscopy and Ho:YAG Laser Lithotripsy: Results from a Tertiary Care Referral Center |
title_full_unstemmed | Understanding the Role of Ureteral Access Sheath in Preventing Post-Operative Infectious Complications in Stone Patients Treated with Ureteroscopy and Ho:YAG Laser Lithotripsy: Results from a Tertiary Care Referral Center |
title_short | Understanding the Role of Ureteral Access Sheath in Preventing Post-Operative Infectious Complications in Stone Patients Treated with Ureteroscopy and Ho:YAG Laser Lithotripsy: Results from a Tertiary Care Referral Center |
title_sort | understanding the role of ureteral access sheath in preventing post-operative infectious complications in stone patients treated with ureteroscopy and ho:yag laser lithotripsy: results from a tertiary care referral center |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9963298/ https://www.ncbi.nlm.nih.gov/pubmed/36835992 http://dx.doi.org/10.3390/jcm12041457 |
work_keys_str_mv | AT villaluca understandingtheroleofureteralaccesssheathinpreventingpostoperativeinfectiouscomplicationsinstonepatientstreatedwithureteroscopyandhoyaglaserlithotripsyresultsfromatertiarycarereferralcenter AT dionipietro understandingtheroleofureteralaccesssheathinpreventingpostoperativeinfectiouscomplicationsinstonepatientstreatedwithureteroscopyandhoyaglaserlithotripsyresultsfromatertiarycarereferralcenter AT candelaluigi understandingtheroleofureteralaccesssheathinpreventingpostoperativeinfectiouscomplicationsinstonepatientstreatedwithureteroscopyandhoyaglaserlithotripsyresultsfromatertiarycarereferralcenter AT ventimigliaeugenio understandingtheroleofureteralaccesssheathinpreventingpostoperativeinfectiouscomplicationsinstonepatientstreatedwithureteroscopyandhoyaglaserlithotripsyresultsfromatertiarycarereferralcenter AT deangelismario understandingtheroleofureteralaccesssheathinpreventingpostoperativeinfectiouscomplicationsinstonepatientstreatedwithureteroscopyandhoyaglaserlithotripsyresultsfromatertiarycarereferralcenter AT corsinichristian understandingtheroleofureteralaccesssheathinpreventingpostoperativeinfectiouscomplicationsinstonepatientstreatedwithureteroscopyandhoyaglaserlithotripsyresultsfromatertiarycarereferralcenter AT robestidaniele understandingtheroleofureteralaccesssheathinpreventingpostoperativeinfectiouscomplicationsinstonepatientstreatedwithureteroscopyandhoyaglaserlithotripsyresultsfromatertiarycarereferralcenter AT fantinmargherita understandingtheroleofureteralaccesssheathinpreventingpostoperativeinfectiouscomplicationsinstonepatientstreatedwithureteroscopyandhoyaglaserlithotripsyresultsfromatertiarycarereferralcenter AT darmaalessia understandingtheroleofureteralaccesssheathinpreventingpostoperativeinfectiouscomplicationsinstonepatientstreatedwithureteroscopyandhoyaglaserlithotripsyresultsfromatertiarycarereferralcenter AT proiettisilvia understandingtheroleofureteralaccesssheathinpreventingpostoperativeinfectiouscomplicationsinstonepatientstreatedwithureteroscopyandhoyaglaserlithotripsyresultsfromatertiarycarereferralcenter AT giustiguido understandingtheroleofureteralaccesssheathinpreventingpostoperativeinfectiouscomplicationsinstonepatientstreatedwithureteroscopyandhoyaglaserlithotripsyresultsfromatertiarycarereferralcenter AT kartalasgoumasioannis understandingtheroleofureteralaccesssheathinpreventingpostoperativeinfectiouscomplicationsinstonepatientstreatedwithureteroscopyandhoyaglaserlithotripsyresultsfromatertiarycarereferralcenter AT brigantialberto understandingtheroleofureteralaccesssheathinpreventingpostoperativeinfectiouscomplicationsinstonepatientstreatedwithureteroscopyandhoyaglaserlithotripsyresultsfromatertiarycarereferralcenter AT montorsifrancesco understandingtheroleofureteralaccesssheathinpreventingpostoperativeinfectiouscomplicationsinstonepatientstreatedwithureteroscopyandhoyaglaserlithotripsyresultsfromatertiarycarereferralcenter AT saloniaandrea understandingtheroleofureteralaccesssheathinpreventingpostoperativeinfectiouscomplicationsinstonepatientstreatedwithureteroscopyandhoyaglaserlithotripsyresultsfromatertiarycarereferralcenter |