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Risk factors for infectious complications after retrograde intrarenal surgery - a systematic review and narrative
Bartosz Dybowski1,2, Ewa Bres-Niewada1,2, Marzena Rzeszutko1
1Department of Urology, Roefler Memorial Hospital, Pruszków, Poland.
Introduction:
Infectious complications are among the most frequent and significant complications in retrograde intrarenal lithotripsy. To date, review articles have covered complications after a ureteroscopy, but not after retrograde intrarenal surgery (RIRS), specifically. Because the complications and risk factors are different for a ureteroscopy and RIRS, we aimed to identify variables related to the occurrence of infectious complications post-RIRS.
Material And Methods:
This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. We included original studies that described 100 or more procedures published in 2014-2021. We extracted data and performed a narrative synthesis to explore and interpret differences between the studies.
Results:
We selected 17 studies for analysis, including 10 from 2019-2021. Infectious complications after RIRS were observed in 2.8-7.5% of patients (mean 7.1%). We found seven independent risk factors associated with infectious complications after RIRS: long operative time, recent history of positive urine culture or urinary tract infection or antibiotic use, pyuria/nitrites, small caliber of ureteral access sheath, struvite stone, high irrigation rate, and comorbidities.
Conclusions:
If an increased rate of infectious complications is found at a RIRS center, countermeasures should include restrictions on operative time and irrigation rate, and consideration of larger access sheaths, especially for patients with abnormal urine results or with struvite stones or with a history of urinary tract infection or co-morbidities.
Insights
Infectious complications after retrograde intrarenal surgery (RIRS) occur in 2.8-7.5% of patients. Key risk factors include long operative time, urinary tract issues, and stone type, guiding preventative strategies.
Area of Science:
- Urology
- Nephrology
- Infectious Diseases
Background:
- Infectious complications are frequent after retrograde intrarenal surgery (RIRS).
- Previous reviews focused on ureteroscopy complications, not specifically RIRS.
- RIRS presents unique complications and risk factors distinct from ureteroscopy.
Purpose of the Study:
- To identify variables associated with infectious complications following RIRS.
- To provide a focused analysis of RIRS-specific infectious complication risk factors.
Main Methods:
- Systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.
- Inclusion of original studies with 100+ procedures published between 2014-2021.
- Narrative synthesis of extracted data to interpret findings.
Main Results:
- Seventeen studies (10 from 2019-2021) were analyzed.
- Infectious complications post-RIRS ranged from 2.8% to 7.5% (mean 7.1%).
- Seven independent risk factors identified: operative time, prior UTI/antibiotic use, pyuria/nitrites, small ureteral access sheath caliber, struvite stones, high irrigation rate, and comorbidities.
Conclusions:
- Countermeasures for high infectious complication rates include limiting operative time and irrigation.
- Consideration of larger ureteral access sheaths is recommended.
- Special attention should be given to patients with abnormal urine, struvite stones, prior UTIs, or comorbidities.
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