林冠榮、黃逸修、李宏耕、黃奕燊、范玉華、林志杰、林子平、鍾孝仁、郭俊逸、黃志賢、      吳宏豪、張延驊、林登龍、陳光國

台北榮民總醫院 泌尿部, 國立陽明大學醫學院 泌尿學科, 書田泌尿科學研究中心

 

Kuan-Jung Lin, Eric YH Huang, Hung Keng Li, I-shen Huang, Yu-Hua Fan, Chi-Cheh Lin, Tzu-Ping Lin, Hsiao-Jen Chung, Junne-Yih Kuo, William JS Huang, Howard HH Wu, Yen-Hwa Chang, Alex TL Lin, Kuang-Kuo Chen

Department of Urology, Taipei Veterans General Hospital

Department of Urology, School of Medicine, National Yang-Ming University and

Shu-Tien Urological Science Research Center, Taipei, Taiwan

 

Objectives: We evaluated whether the risks of postoperative infection will be increased in patients with mild pyuria before ureteroscopic lithotripsy (URSL) in a prospective study.

 

Materials and Methods: We prospectively enrolled patients receiving URSL from 2011/5 to 2015/2. The patients with normal urine routine (sediment WBC ≤5/HPF) before URSL were assigned as control, and those with mild pyuria (sediment 5/HPF < WBC ≤50/HPF ) as experimental group. Febrile UTI, patients < 18 years, pregnant, and urine sediment WBC > 50/HPF were excluded. All patients received same protocol of preoperative and postoperative antibiotics. Pre-, intra-operative, and post-operative urine routine and culture were collected. Peri-operative data were compared. Post-operative pyuria, febrile episodes, and percentage of emergency room visits were also compared.

 

Results: 140 patients were enrolled (experimental: 53, control: 87). Mean age was 56.6 and 55.5 years, respectively. Patient’s BMI, stone laterality, stone location, and percentage of male patients were similar in both groups. The mean stone size was 0.84cm vs. 0.76cm (p=0.243).  The operation duration was 58.8 vs. 49.2 min (p=0.022). The stone free rate was 92.5% vs. 90.8%(p=0.235). Four out of 23 patients in experimental group had positive pre-operative urine culture, two were E Coli, and two Gram positive coccus. Two out of 12 patient in control group had positive pre-operative urine culture, one was E. Coli and one was coagulase negative staphylococcus group. Two out of 33 patients had positive intra-operative urine culture in experimental group: one pseudomonas, one enterococcus species. One out of 46 patients had positive intra-operative urine culture which was enterococcus species. Both pre-operative culture and intra-operative culture didn’t reach statistical significance(p=0.398, 0.477 respectively).  Two patients (3.8%) in the experiment group and none in control group had post-operative fever but didn’t reach statistical significance (p=0.068)

 

Conclusions: The incidence of postoperative fever increased in patients with mild pyuria before URSL but didn't reach significance compared to patients with sterile urine.