PDF(Pubmed)
Abstract：
Background: Retrograde intrarenal surgery (RIRS) using flexible ureterorenoscopes is a cornerstone approach for renal stone removal, yet it carries a significant risk of postoperative urinary tract infection (UTI). With the emergence of single-use ureterorenoscopes, there is growing interest in their potential to mitigate this risk. This study aimed to compare the postoperative infection rates between single-use and multi-use ureterorenoscopes in RIRS procedures and to identify predictors of postoperative UTI. Methods: Data were collected from 112 consecutive patients who underwent RIRS for renal stones between March 2022 and September 2023. Peri-operative variables including age, gender, body mass index (BMI), stone size, stone location, type of ureterorenoscope, Hounsfield Units (HU), pre-operative hydronephrosis, laboratory analysis, and operative time were evaluated. Univariate and multivariate logistic regression analyses were performed to assess the predictors of postoperative UTI. Results: Of the cohort, 77 surgeries (68.7%) utilized multi-use ureterorenoscopes, while 35 (31.3%) utilized single-use devices. Stone diameter, number of stones, type of ureterorenoscope, and operative time were significant predictors of postoperative UTI in the univariate analysis. Multivariable logistic regression showed that operative time (OR, 1.3; 95% CI, 0.55-0.99; p = 0.03) and type of ureterorenoscope (multi-use vs. single-use) (OR, 1.14; 95% CI, 1.08-1.2; p < 0.001) were independent predictors of postoperative UTI. Conclusions: In conclusion, this study highlights that multi-use ureterorenoscopes and prolonged operative time are associated with an increased risk of postoperative UTI in RIRS procedures. Careful pre-operative evaluation and meticulous patient selection are essential to minimize the occurrence of postoperative UTIs and optimize patient outcomes in RIRS for renal stones.
摘要：
背景：使用输尿管肾镜逆行肾内手术（RIRS）是清除肾结石的基石。然而，它具有术后尿路感染（UTI）的重大风险。随着一次性输尿管肾镜的出现，人们对他们减轻这种风险的潜力越来越感兴趣。这项研究旨在比较RIRS手术中单次使用和多次使用输尿管肾镜的术后感染率，并确定术后UTI的预测因素。方法：从2022年3月至2023年9月期间接受RIRS治疗肾结石的112例连续患者中收集数据。围手术期变量，包括年龄，性别,体重指数（BMI），石头尺寸,石头位置,输尿管肾镜类型，HounsfieldUnits(HU),术前肾积水,实验室分析,评估手术时间。进行单变量和多变量逻辑回归分析以评估术后UTI的预测因子。结果：在队列中，77例手术(68.7%)使用了多用途输尿管肾镜，35人(31.3%)使用一次性设备。石块直径,石头的数量,输尿管肾镜类型，在单因素分析中，手术时间和手术时间是术后UTI的重要预测因素。多变量logistic回归显示手术时间(OR，1.3；95％CI，0.55-0.99；p=0.03）和输尿管肾镜的类型（多次使用与一次性使用)(或，1.14；95%CI，1.08-1.2；p<0.001）是术后UTI的独立预测因子。结论：总之，本研究强调,在RIRS手术中,多次使用输尿管肾镜和延长手术时间与术后UTI风险增加相关.仔细的术前评估和细致的患者选择对于最大程度地减少术后UTI的发生并优化RIRS治疗肾结石的患者结果至关重要。
