Concomitant urinary tract infections in retrograde intrarenal surgery (RIRS)

Abstract

Introduction: Urinary stones affect approximately 5 to 15% of the population in developed countries and depend on geographical location, age and gender. Laser lithotripsy has already become established worldwide as a preferred method for their treatment in urological practice. At present, retrograde intrarenal surgery (RIRS) has shown a high success rate and an acceptable number of complications. Recent studies show a complication rate of 9 to 25% of ureteroscopic procedures in different parts of the world. Urinary tract infections, ureteral lesions, hematuria, and postoperative renal colic are the most common complications in this type of surgery. Aim: The main goal of our study is to analyze the characteristics and risk factors of complicated urinary tract infections during retrograde intrarenal surgery and to look for the most effective options for their prevention and treatment. Materials and Methods:  The study was conducted in two university hospitals in Varna and Sofia under relatively similar conditions and equipment. Between January 2019 and June 2020, this study retrospectively included 324 patients who underwent RIRS for the treatment of kidney stones with 212 patients undergoing laser treatment at the Clinic of Urology at St. Marina University Hospital, Varna, and 112 patients—in the Urology Department at Sofiamed University Hospital, Sofia. Results:  The overall incidence of postoperative urinary tract infections was 14.5% (47/324 patients). The mean age of the patients was 52.8 ± 13.1 years, out of 324 patients, 217 patients (67%) were men and 107 patients (33%) were women. Major diseases included diabetes mellitus—52 (16%), and chronic kidney disease 16 (4.9%). Conclusion:  Despite adequate prophylactic measures, postoperative urinary tract infections after ureteroscopy (URS) were found in 14.5% of the cases of this study and the most commonly found microorganism, which was isolated in more than half of patients with febrile urinary tract infection, was E. coli . In addition, it is necessary to reduce the operative working time, because this is the most important factor that prevents postoperative urinary tract infection.