Risk of Urosepsis in Patients Undergoing Ureteroscopy for Stone Disease

26 Apr, 21

Introduction

Ureteroscopy (URS) is the most common treatment for ureteral and renal stones and is widely used in higher risk patients due to high success rates. However, this might increase the risk of postprocedural infectious complications. The risk factors for urosepsis post URS are not well characterized. Identification of risk factors specifically for postoperative urosepsis might be beneficial in risk stratification before URS.

Aim

This systematic review with meta-analysis aimed to identify potential risk factors for urosepsis after URS for stone disease.

Method

Study Design

Systematic review and meta-analysis

Treatment Strategy

Systematic searches of Medline, Embase, and the Cochrane Central Register of Controlled Trials was conducted to identify the studies of patients undergoing URS for renal stones.
Cohort and case-control for studies reporting at least one prospectively defined risk factor for urosepsis after URS were included.
Studies that only reported rates of isolated fever, urinary tract infection (UTI), or pooled infectious complications were excluded from analysis.
Various risk factors like age, sex, body mass index, diabetes mellitus, ischemic heart disease, recent UTI, pyuria, hydronephrosis, stone history, stone size, preoperative stent placement, preoperative positive urine culture, and procedure time were assessed.
A random effects meta-analysis model with inverse variance weighting was used where the statistic of interest was the odds ratio (OR) for dichotomous variables and the mean difference for continuous outcomes.

Endpoints

Pooled incidence of postoperative urosepsis
Risk factors for postoperative urosepsis

Results

Among the selected 13 studies (5 prospective) with 5597 patients, 64% were men and mean age ranged between 43 to 77 years
Mean procedure time ranged from 24 to 97 mins and postoperative urosepsis rates varied between 0.2% to 17.8%
The pooled incidence of postoperative urosepsis was 5.0% (95% confidence interval: 2.4-8.2).
Among 13 risk factors assessed, 6 were statistically associated with increased postoperative urosepsis risk
- Preoperative stent placement (odds ratio = 3.94, p < 0.001, 6 studies),
- Positive preoperative urine culture (OR = 3.56, p < 0.001, 6 studies),
- Ischemic heart disease (OR = 2.49, p = 0.002, 2 studies),
- Older age (mean difference = 2.7 years, p = 0.002, 6 studies),
- Longer procedure time (mean difference = 9 minutes, p = 0.02, 1 study),
- Diabetes mellitus (OR = 2.04, p = 0.04, 6 studies).

Conclusion

This meta-analysis demonstrated a 5% risk of postoperative urosepsis among patients undergoing ureteroscopy for treatment of stone disease.
Older age, diabetes mellitus, ischemic heart disease, preoperative stent placement, a positive preoperative urine culture, and longer procedure time were independently associated with increased postoperative urosepsis risk.
These findings will help the urologists with preoperative risk stratification before ureteroscopic procedures.

J Endourol. 2021 Mar 15. Doi: 10.1089/end.2020.1133.