Standardization of retrograde intrarenal surgery with "gravity irrigation" technique leads to low postoperative infection rate regardless of surgeon experience

M. Antonucci; Daniele Castellani; Giorgia Tema; Angelo Territo; M. De Dominicis; Lorenzo Defidio

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Standardization of retrograde intrarenal surgery with "gravity irrigation" technique leads to low postoperative infection rate regardless of surgeon experience

Antonucci, Michele ^[3] ; Castellani, Daniele ^[1] ; Tema, Giorgia ^[4] ; Territo, Angelo ^[5] ; Dominicis, Mauro De ^[3] ; Defidio, Lorenzo ^[2]
1. [1] Marche Polytechnic University
  
  Marche Polytechnic University
  
  Ancona, Italia
2. [2] Ospedale Cristo Re
  
  Ospedale Cristo Re
  
  Roma Capitale, Italia
3. [3] "Cristo Re" Hospital, Rome, Italia
4. [4] Sapienza Università di Roma, Rome, Italia
5. [5] Fondaccio Puigvert, Barcelona
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Localización: Archivos españoles de urología, ISSN 0004-0614, Tomo 75, Nº. 4 (Mayo), 2022, págs. 339-345
Idioma: inglés
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Resumen
- Objectives: We aimed to evaluate the prevalence and predictive factors of postoperative infections after a standardized low-pressure RIRS technique. The secondary outcome was comparing surgeons’ experience in terms of infective complication and stone-free rate.
  
  Methods: A single-center retrospective analysis was conducted on all patients who underwent RIRS for kidney stones between January 2018 and February 2019. Inclusion criteria: adults, stone ≤ 20 mm (unless percutaneous nephrolithotomy contraindications). Concomitant ureteral lithotripsy was allowed. Exclusion criteria: bilateral surgery, active urinary tract infections (UTI), pregnancy, fever at surgery. Low-pressure RIRS and ureteroscopy was achieved with gravity irrigation, a 5 Ch open-ended urethral catheter (ureteral lithotripsy), intravenous furosemide (20 mg), and ureteral access sheath above the ureteral-pelvic junction (RIRS).
  
  Results: 236 patients were included in the analysis. Mean age was 55.89±13.96 years. Mean stone diameter was 14.28±5.81mm. 43 (18.2%) patients underwent concomitant ureteral lithotripsy. Mean operative time was 61.10 ± 31.36 minutes. Infective complications occurred in 13 (5.5%) patients. Sepsis occurred in 10 (4.2%) patients and septic shock occurred in 1 (0.4%). One patient (0.4%) required stent substitution. Multivariate logistic regression analysis showed that history of UTI predicted for higher risk of postoperative infections (OR 8.434, CI 95% 2.36–29.46). Outcomes comparison of surgical expertise did not statistically differ in terms of stone-free rate and infective complications.
  
  Conclusion: Our standardized RIRS technique achieved a low postoperative infective complication rate. History of UTI was the strongest predictor of postoperative infections.