Department of Urology. Istanbul Medeniyet University Goztepe Training and Research Hospital. Istanbul. Turkey.
Arch Esp Urol. 2021 Jun;74(5):503-510.
The goal of current study was to evaluate prevalence of postoperative urinary tract infections (UTI) following flexible ureteroscopy (f-URS) and to determine predictive factors for those UTIs.
A total of 420 patients with urolithiasis that underwent f-URS between August 2018 and August 2019 were enrolled in the study. Peri-operative characteristics of patients with and without postoperative UTIs were compared using univariate analyses. Predictive factors for UTIs following f-URS were determined using multivariate logistic regression analysis.
Forty-one (9.8%) out of 420 patients had postoperative urinary infection after f-URS and those patients were classified as group 1. Group 2 consisted of 379 patients that did not develop postoperative UTIs. The percentage of female gender was 58.5% vs 42% in groups 1 and 2, respectively (p=0.042). The preoperative UTI history rate was 51.2% vs 20.8% (p<0.001) and preoperative double J stent (DJS) insertion rate 39% vs 17.7% in groups 1 and 2, respectively (p=0.001). Univariate regression analyses showed that the female gender (OR=1.98), history of UTI (OR=3.99), and preoperative DJS insertion (OR=2.98) significantly increased the possibility of postoperative UTI (p<0.05). Multivariate regression analyses revealed that history of UTI (OR=3.41, 95%CI:1.73-6.72, p<0.001) and preoperative DJS insertion (OR=2.30, 95%CI:1.13-4.68, p=0.021) were independent risk factors for infectious complications following f-URS. If both factors are present, the probability of infection is 55.2%.
Even if f-URS is considered a safe procedure, the risk of postoperative infectious complications is far from negligible. We found that the presence of UTI history and preoperative DJS were independent risk factors for UTI after f-URS.
本研究旨在评估软性输尿管镜检查（f-URS）后术后尿路感染（UTI）的发生率，并确定这些 UTI 的预测因素。
本研究共纳入 2018 年 8 月至 2019 年 8 月期间因肾结石接受 f-URS 的 420 例患者。采用单因素分析比较有和无术后 UTI 患者的围手术期特征。采用多因素 logistic 回归分析确定 f-URS 后 UTI 的预测因素。
420 例患者中有 41 例（9.8%）在 f-URS 后发生术后尿路感染，将这些患者分为第 1 组。第 2 组由 379 例未发生术后 UTI 的患者组成。第 1 组和第 2 组的女性比例分别为 58.5%和 42%（p=0.042）。第 1 组术前 UTI 病史率为 51.2%，第 2 组为 20.8%（p<0.001），术前双 J 支架（DJS）置入率第 1 组为 39%，第 2 组为 17.7%（p=0.001）。单因素回归分析显示，女性（OR=1.98）、UTI 病史（OR=3.99）和术前 DJS 置入（OR=2.98）显著增加术后 UTI 的可能性（p<0.05）。多因素回归分析显示，UTI 病史（OR=3.41，95%CI：1.73-6.72，p<0.001）和术前 DJS 置入（OR=2.30，95%CI：1.13-4.68，p=0.021）是 f-URS 后感染性并发症的独立危险因素。如果这两个因素都存在，感染的概率为 55.2%。
即使 f-URS 被认为是一种安全的手术，但术后感染性并发症的风险远不能忽视。我们发现，UTI 病史和术前 DJS 的存在是 f-URS 后 UTI 的独立危险因素。
