逆行性腎臟內視鏡手術及鈥雷射治療腎結石後造成感染的風險因子評估

黃詩孟¹、李高漢¹、曾文歆¹、林才揚¹、謝昆霖¹、蘇家震¹、王致丞¹、陳俊豪¹、劉建良¹、黃冠華¹

¹奇美醫療財團法人永康奇美醫院外科部泌尿外科

Risk Factors of Infectious Complications after Retrograde Intrarenal Surgery with Holmium Laser for Renal Stones

Shih-Meng Huang¹、Kau-Han Lee¹、Wen-Hsin Tseng¹、Chye-Yang Lim¹、Kun-Lin Hsieh¹、Chia-Cheng Su¹、Jhih-Cheng Wang¹、Chun-Hao Chen¹、Chien-Liang Liu¹、Steven Kuan-Hua Huang¹

¹Division of Urology,Department of Surgery,Chi Mei Medical Center,Tainan,Taiwan

Purpose:

To investigate the risk factors and predict postoperative infectious complications after retrograde intrarenal surgery (RIRS) with Holmium laser for renal stones.  

Materials and methods:

Total 146 patients who underwent RIRS with Holmium for renal stones between January 2019 and January 2022. Patients were divided into two groups as with and without postoperative infection complications,including fever,SIRS(systemic inflammatory response syndrome) and sepsis. The demographic data,perioperative findings and post-operative complications of all patients were retrospectively reviewed. Sterile urine cultures and urine analysis were obtained in all patients during the preoperative 7-day period.

Results:

Post-operative infectious complications was noted in 17 (11.6%) of 146 patients,including 8(5.4%) sepsis. Patient demographics were similar between groups,except more female in the infection group(59% vs 34%,p=0.045). There was no statistically significant difference between the two groups in terms of pre-operative renal insufficiency,leukocytosis,hydronephrosis and antibiotics use,operation time,stone location,and use of ureteral access sheath or single-use ureteroscope. Patients with postoperative infectious complications had a higher rate of preoperative percutaneous nephrostomy (24% vs 6%, p=0.035),larger stone size(16 vs 13 mm, p=0.042) and higher rates of residule stones. Rate of preoperative pyuria(88% vs 50%,p=0.002) and positive urine culture(59% vs 32%,p=0.029) were also observed more frequently in patients with postoperative infection.

Conslusion:

Pyeuria in preoperative urine analysis,preoperative positive urine culture,larger stone size and preoperative PCN insertion are the risk factors that predict the postoperative infectious complications in RIRS with Holmium laser for renal stones. Also,post-operative residule stones was a risk factor of infection.