Kazan Huseyin Ozgur, Cakici Mehmet Caglar, Efiloglu Ozgur, Cicek Muhammet, Yildirim Asif, Atis Ramazan Gokhan
Department of Urology. Istanbul Medeniyet University Goztepe Research and Training Hospital Istanbul. Turkey.
Arch Esp Urol. 2020 Sep;73(7):634-642.
Ureteroscopic lithotripsy (URS) is the current standard choice of treatment for both ureteral and adequate renal stones. Although it is known to be a safe procedure, postoperative febrile urinary tract infection (UTI) is not rare. Especially in diabetic patients, rate of urinary tract infection is higher. Therefore, we aimed to describe the risk factors for UTI following URS in diabetics. MATERIALS AND METHODS: Between January 2017and April 2019, 546 patients who under went ureteroscopic lithotripsy for ureteral and/or renal stones were included. A matched-pair analysis was performed to compare postoperative UTI rates between diabetics and nondiabetics. We retrospectively reviewed the medical records including age, gender, BMI, comorbidities, UTI history, hemoglobin A1c (HbA1c), operating time, stone size and hounsfield unit (HU), preoperative hydronephrosis, ureteroscopic methods and ureteral stenting. Logistic regression analysis was done to determine the risk factors for postoperative UTI in diabetics. RESULTS: In diabetic patients rate of postoperative UTI was 29% (13/45). After matched-pair analysis within the group of non-diabetics, incidence was 11% (5/44) (p=0.04). In univariate analysis, preoperative ureteral stent, UTI history and HbA1c level were the risk factors for UTI after URS in diabetics. UTI history and HbA1clevel were the independent risk factors for developing postoperative UTI in diabetic patients. HbA1c threshold 6.9% afforded 75% sensitivity and 67% specificity for predicting postoperative UTI in diabetics.
Diabetic patients are under greater risk to develop postoperative UTI following URS. Those patients with UTI history and HbA1c level higher than 6.9% must be followed carefully.
输尿管镜碎石术（URS）是目前治疗输尿管结石和合适大小肾结石的标准选择。尽管已知该手术是安全的，但术后发热性尿路感染（UTI）并不罕见。尤其是糖尿病患者，尿路感染发生率更高。因此，我们旨在描述糖尿病患者URS术后UTI的危险因素。
纳入2017年1月至2019年4月间546例行输尿管镜碎石术治疗输尿管和/或肾结石的患者。采用配对分析比较糖尿病患者和非糖尿病患者术后UTI发生率。我们回顾性分析病历，包括年龄、性别、体重指数、合并症、UTI病史、糖化血红蛋白（HbA1c）、手术时间、结石大小和亨氏单位（HU）、术前肾积水、输尿管镜检查方法和输尿管支架置入情况。采用逻辑回归分析确定糖尿病患者术后UTI的危险因素。
糖尿病患者术后UTI发生率为29%（13/45）。在非糖尿病组进行配对分析后，发生率为11%（5/44）（p=0.04）。单因素分析显示，术前输尿管支架置入、UTI病史和HbA1c水平是糖尿病患者URS术后UTI的危险因素。UTI病史和HbA1c水平是糖尿病患者术后发生UTI的独立危险因素。HbA1c阈值6.9%预测糖尿病患者术后UTI的敏感性为75%，特异性为67%。
糖尿病患者URS术后发生UTI的风险更高。对有UTI病史且HbA1c水平高于6.9%的患者必须密切随访。
