“Stratifying the risk factors for sepsis post ureteroscopic lithotripsy” – a prospective study

Background: Postoperative infections are one of the most common complications of ureteroscopic lithotripsy with about 1% incidence, preoperative use of prophylactic antibiotics is insufficient. To our knowledge only few clinical studies have reported on these infectious complications and on the risk factors related to infectious complications. The purpose of our study is to identify risk factors for sepsis with URSL in order to take advantage of modifiable factors to prevent sepsis onset and identify high risk patients in order to prevent additional complications
Methods: We prospectively collected the data of 200 patients with ureteric stones who underwent ureteroscopic lithotripsy at our hospital from sept 2016 to august 2017, including age, gender, comorbidity, urine analysis, urine culture, stone size, operative duration, previous stone surgery. Patients with and without sepsis where classified into group A and group B respectively. All the risk factors were assessed using chi-square test, Mann-Whitney U test, Fischer’s exact test.
Results –all surgeries where successfully completed. The total stone free rate was 82 %( n=164). The incidence of infectious complications after URSL was 8.5 %( n=17). Analysis of group A and B indicated that operative duration, stone size, pyuria were risk factors for sepsis after URSL.
Conclusion- Antibiotics should be routinely administered to patients 2-3 days before URSL is performed, particularly for patients with pyuria., The operative duration should be controlled to the extent possible. , For large stone, fragmentation of stone to 3-4mm size is better