Omori Chihiro, Hori Shunta, Otsuka Kenji, Iida Kota, Morizawa Yosuke, Naoi Makito, Tani Mitsuru, Nakagawa Yoshinori
Department of Urology, Yamatotakada Municipal Hospital.
Department of Urology, Hoshigaoka Medical Center.
Nihon Hinyokika Gakkai Zasshi. 2018;109(2):74-84. doi: 10.5980/jpnjurol.109.74.
(Objectives) Transurethral Ureterolithotripsy (TUL) has become an increasingly more common treatment for ureteric stones since the reduction in ureteroscope diameter and other device improvements. At the same time, TUL sometimes shows postoperative febrile urinary tract infection (fUTI) with severe complications. Therefore we investigated the occurrence and risk factors of fUTI in our hospital, and assessed the effect of antibiotic prophylaxis prior to TUL. (Materials and methods) The subjects were 260 patients who underwent TUL in our department during the period from January 2011 to October 2014. We retrospectively reviewed the data of those who developed postoperative fUTI and identified the risk factors of postoperative fUTI. From November 2014 to August 2016, we enrolled 110 patients undergoing TUL with one or more risk factors in a prospective clinical trial of prophylactic oral levofloxacin (500 mg) for 1 week before TUL. The chi-squared test, Mann-Whitney U-test, and logistic regression analysis were used for data analysis (significance level of 0.05). (Results) Postoperative fUTI occurred in 43 (16.5%) of 260 patients. The risk factors of postoperative fUTI included preoperative pyelonephritis (P=0.02), preoperative ureteral stent placement (P=0.017), and operative time >90 min (P=0.005). Operative time was correlated with and could be substituted for pre-TUL stone size (P<0.0001). Chemopreventive therapy before TUL in patients with preoperative pyelonephritis, preoperative ureteral stent placement, or stones of >20 mm significantly reduced their risk of fUTI (P=0.012). (Conclusions) The use of antibiotic prophylaxis significantly reduces the risk of postoperative fUTI in patients with preoperative pyelonephritis, preoperative ureteral stent placement, or stones of >20 mm.
（目的）随着输尿管镜直径减小及其他设备改进，经尿道输尿管碎石术（TUL）已成为治疗输尿管结石越来越常用的方法。与此同时，TUL有时会出现术后发热性尿路感染（fUTI）并伴有严重并发症。因此，我们调查了我院fUTI的发生率及危险因素，并评估了TUL术前抗生素预防的效果。（材料与方法）研究对象为2011年1月至2014年10月期间在我科接受TUL的260例患者。我们回顾性分析了发生术后fUTI患者的数据，并确定了术后fUTI的危险因素。2014年11月至2016年8月，我们将110例有一个或多个危险因素的接受TUL的患者纳入一项前瞻性临床试验，在TUL前口服左氧氟沙星（500mg）预防1周。采用卡方检验、曼-惠特尼U检验和逻辑回归分析进行数据分析（显著性水平为0.05）。（结果）在260例患者中，43例（16.5%）发生了术后fUTI。术后fUTI的危险因素包括术前肾盂肾炎（P=0.02）、术前输尿管支架置入（P=0.017）和手术时间>90分钟（P=0.005）。手术时间与TUL术前结石大小相关且可相互替代（P<0.0001）。对于术前有肾盂肾炎、术前输尿管支架置入或结石>20mm的患者，TUL术前进行化学预防治疗可显著降低其发生fUTI的风险（P=
