Dassanayake Sohani N, Harrison Nicholas L, Traxer Olivier, Gauhar Vineet, Yuen Steffi K K, Somani Bhaskar K
University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, Hampshire, UK.
Mersey and West Lancashire Teaching Hospitals NHS Trust, Prescot, UK.
World J Urol. 2025 Jul 12;43(1):432. doi: 10.1007/s00345-025-05790-3.
The aim of this study was to ascertain the mortality associated with ureteroscopy (URS) in the management of kidney stone disease (KSD), with a focus to identify relevant risk factors and highlight key learning points to prevent and reduce mortality from URS.
A literature search was conducted across Medline, Embase, CINAHL and Cochrane library, in line with PRISMA guidelines. This study focused on mortality of patients that underwent URS for KSD. Inclusion criteria included English articles of adult and paediatric patients which reported on mortality from URS. Data extracted included patient demographics, co-morbidities, procedure characteristics, number of deaths, complications, and cause of death.
After screening, 24 articles were eligible and reported on 1,057,707 patients, across all continents. A total of 1,009 deaths were reported following URS. Sepsis and infection were the most common cause of death in 84.5% of reported cases. The key insights affecting mortality were grouped into two domains: patient factors and operative factors. The former included older age, co-morbidities, and the importance of comprehensive assessment for treatment decisions. The latter focused on infection screening, appropriate prophylactic antibiotics, reduced intrarenal pressure, use of ureteral access sheaths, timely stent removal and infection management.
Infection and urosepsis are major contributors of mortality following ureteroscopy. Efforts must be made pre and peri operatively to mitigate these. Special care must be taken in the elderly and patients with comorbidities.
本研究旨在确定输尿管镜检查（URS）在肾结石疾病（KSD）管理中的死亡率，重点是识别相关风险因素并突出关键经验教训，以预防和降低URS导致的死亡率。
根据PRISMA指南，在Medline、Embase、CINAHL和Cochrane图书馆进行文献检索。本研究聚焦于接受URS治疗KSD的患者的死亡率。纳入标准包括报道URS死亡率的成人和儿科患者的英文文章。提取的数据包括患者人口统计学、合并症、手术特征、死亡人数、并发症和死因。
筛选后，24篇文章符合要求，报道了来自各大洲的1,057,707例患者。URS后共报告1,009例死亡。脓毒症和感染是84.5%报告病例中最常见的死亡原因。影响死亡率的关键见解分为两个领域：患者因素和手术因素。前者包括年龄较大、合并症以及综合评估对治疗决策的重要性。后者侧重于感染筛查、适当的预防性抗生素、降低肾内压力、使用输尿管通路鞘、及时取出支架和感染管理。
感染和尿脓毒症是输尿管镜检查后死亡率的主要原因。必须在术前和术中努力减轻这些情况。对老年人和合并症患者必须特别小心。
