Department of Urology, Istanbul Medeniyet University Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Türkiye.
Department of Urology, Van Training and Research Hospital, Van, Türkiye.
Urologia. 2024 Feb;91(1):147-153. doi: 10.1177/03915603231210604. Epub 2023 Nov 27.
There is no recommendation on the timing of ureterolithotripsy after the treatment of obstructive acute pyelonephritis (APN). The effect of early and delayed ureterolithotripsy on postoperative urinary tract infection (UTI) and other complications was investigated.
Patients who underwent ureterolithotripsy after obstructive APN treatment between February 2017 and August 2021 were divided into two groups, those operated during hospitalization and those operated within 3 months after discharge. Two groups were compared in terms of stone-free status, postoperative complications, postoperative UTI, and urosepsis rates.
Of the 91 patients included in the study, 68 were in the early ureterolithotripsy group, while 23 patients were in the delayed ureterolithotripsy group. The postoperative UTI rate was significantly higher in patients who underwent early ureterolithotripsy (29.4% vs 8.7%, = 0.045). Patients with postoperative UTI had a higher moderate/severe perinephric fat stranding (PFS) on non-contrast CT at hospital admission (52.2% vs 29.4%, = 0.048). Among the laboratory parameters, white blood cells were significantly higher in the group with postoperative UTI (21604.5 vs 14728.9, = 0.042). In the multivariate analysis, early ureterolithotripsy and moderate/severe PFS were independent predictors for postoperative UTI. In the created model, the probability of postoperative UTI after ureterolitripsy after obstructive APN treatment was 3.5% in patients without risk factors, while this rate was 51.9% in patients with both risk factors.
There is no consensus on the timing of stone removal after treatment of obstructive APN. Early ureterolithoripsy and moderate/severe perinephric fat stranding on non-contrast CT are risk factors for postoperative UTI.
对于梗阻性急性肾盂肾炎（APN）治疗后输尿管镜碎石术的时机，目前尚无推荐意见。本研究旨在探讨早期和延迟输尿管镜碎石术对术后尿路感染（UTI）和其他并发症的影响。
回顾性分析 2017 年 2 月至 2021 年 8 月期间因梗阻性 APN 接受输尿管镜碎石术的患者资料，根据手术时机分为两组，住院期间手术组（早期）和出院后 3 个月内手术组（延迟）。比较两组患者的结石清除率、术后并发症、术后 UTI 和尿脓毒症发生率。
本研究共纳入 91 例患者，其中 68 例行早期输尿管镜碎石术，23 例行延迟输尿管镜碎石术。早期组患者术后 UTI 发生率显著高于延迟组（29.4%比 8.7%， = 0.045）。术后发生 UTI 的患者入院时非增强 CT 上中度/重度肾周脂肪条纹（PFS）的比例更高（52.2%比 29.4%， = 0.048）。在实验室参数方面，术后 UTI 组白细胞计数显著高于无 UTI 组（21604.5 比 14728.9， = 0.042）。多因素分析显示，早期输尿管镜碎石术和中度/重度 PFS 是术后 UTI 的独立预测因素。在创建的模型中，梗阻性 APN 治疗后行输尿管镜碎石术患者无危险因素时术后 UTI 的概率为 3.5%，有危险因素时术后 UTI 的概率为 51.9%。
对于梗阻性 APN 治疗后结石清除的时机目前尚无共识。早期输尿管镜碎石术和非增强 CT 上中度/重度肾周脂肪条纹是术后 UTI 的危险因素。
