Hongbo Xu, Kefeng Wu, Yilun Chen, Qinggang Wang, Meng Ding, Jianwen Li, Bing Lu, Shoujun Zhou, Jianquan Hou
Department of Urology, The Fourth Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.
World J Urol. 2025 Oct 29;43(1):640. doi: 10.1007/s00345-025-06013-5.
Retrograde intrarenal surgery (RIRS) is widely used for treating renal stones, but postoperative sepsis remains a significant complication. This study aimed to evaluate whether the novel tip-bendable suction ureteral access sheath (S-UAS) reduces post-RIRS sepsis compared to traditional ureteral access sheaths (T-UAS).
We retrospectively analyzed 233 patients undergoing RIRS for renal stones between February 2021 and October 2024. Patients were divided into S-UAS and T-UAS groups. The primary endpoint was postoperative sepsis, assessed using both the Systemic Inflammatory Response Syndrome (SIRS) and quick Sequential Organ Failure Assessment (qSOFA) criteria. Multivariate logistic regression was used to identify independent risk factors.
The S-UAS group showed significantly lower rates of postoperative fever (17.7% vs. 29.4%, p = 0.036), SIRS (7.3% vs. 22.0%, p = 0.001), and qSOFA criteria fulfillment (2.4% vs. 10.1%, p = 0.014). Immediate and 30-day stone-free rates were significantly higher with S-UAS (76.6% vs. 42.2%, p < 0.001 and 79.8% vs. 56.9%, p < 0.001, respectively). The median postoperative hospital stay was significantly lower in the S-UAS group compared to the T-UAS group (2d vs. 3d, p < 0.001). Multivariate analysis confirmed S-UAS as an independent protective factor against post-RIRS sepsis (OR 0.164, 95% CI 0.052-0.519, p = 0.002 for SIRS; OR 0.222, 95%CI 0.056-0.883, p = 0.033 for qSOFA).
The S-UAS significantly reduces the risk of postoperative sepsis following RIRS while improving stone-free rates.
逆行性肾内手术（RIRS）广泛应用于肾结石治疗，但术后脓毒症仍是一种严重并发症。本研究旨在评估新型可弯曲尖端的输尿管鞘（S-UAS）与传统输尿管鞘（T-UAS）相比，是否能降低RIRS术后脓毒症的发生率。
我们回顾性分析了2021年2月至2024年10月期间233例行RIRS治疗肾结石的患者。将患者分为S-UAS组和T-UAS组。主要终点是术后脓毒症，采用全身炎症反应综合征（SIRS）和快速序贯器官衰竭评估（qSOFA）标准进行评估。采用多因素logistic回归分析确定独立危险因素。
S-UAS组术后发热率（17.7% vs. 29.4%，p = 0.036）、SIRS发生率（7.3% vs. 22.0%，p = 0.001）和qSOFA标准符合率（2.4% vs. 10.1%，p = 0.014）显著较低。S-UAS组的即刻无石率和30天无石率显著更高（分别为76.6% vs. 42.2%，p < 0.001；79.8% vs. 56.9%，p < 0.001）。S-UAS组术后中位住院时间显著低于T-UAS组（2天 vs. 3天，p < 0.001）。多因素分析证实S-UAS是RIRS术后脓毒症的独立保护因素（SIRS：OR 0.164，95%CI 0.052 - 0.519，p = 0.002；qSOFA：OR 0.222，95%CI 0.056 - 0.883，p = 0.033）。
S-UAS显著降低了RIRS术后脓毒症的风险，同时提高了无石率。
