逆行肾内手术并发尿路感染

I. Velev, D. Anakievski
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摘要

导读:在发达国家,尿路结石影响约5%至15%的人口,并取决于地理位置、年龄和性别。激光碎石术已经在世界范围内成为泌尿外科治疗的首选方法。目前,逆行肾内手术(RIRS)具有较高的成功率和可接受的并发症数量。最近的研究表明,在世界不同地区,输尿管镜手术的并发症发生率为9%至25%。尿路感染、输尿管病变、血尿和术后肾绞痛是这类手术最常见的并发症。目的:分析逆行性肾内手术并发尿路感染的特点及危险因素,寻求最有效的预防和治疗方案。材料和方法:本研究在瓦尔纳和索非亚两所大学医院进行,条件和设备相对相似。在2019年1月至2020年6月期间,该研究回顾性地纳入了324名接受RIRS治疗肾结石的患者,其中212名患者在瓦尔纳圣玛丽娜大学医院泌尿外科诊所接受激光治疗,112名患者在索非亚索菲亚大学医院泌尿外科接受激光治疗。结果:术后尿路感染总发生率为14.5%(47/324例)。患者平均年龄52.8±13.1岁,324例患者中,男性217例(67%),女性107例(33%)。主要疾病包括糖尿病52例(16%)和慢性肾脏疾病16例(4.9%)。结论:尽管采取了充分的预防措施,但本研究中仍有14.5%的病例发生输尿管镜术后尿路感染,其中最常见的微生物是大肠杆菌,在半数以上的发热性尿路感染患者中被分离出来。此外,要减少手术工作时间,因为这是预防术后尿路感染最重要的因素。
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Concomitant urinary tract infections in retrograde intrarenal surgery (RIRS)
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.
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