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Vol. 43. Issue 6.
Pages 293-299 (July - August 2019)
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Vol. 43. Issue 6.
Pages 293-299 (July - August 2019)
Original article
Urinary sepsis after endourological ureterorenoscopy for the treatment of lithiasis
Sepsis urinaria tras tratamiento endourológico de la litiasis por ureterorrenoscopia
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D. Díaz Pérez
Corresponding author
daviddiaz.uro@gmail.com

Corresponding author.
, I. Laso García, C. Sánchez Guerrero, Á. Fernández Alcalde, M. Ruiz Hernández, J. Brasero Burgos, J. Lorca Álvaro, G. Duque Ruiz, F. Arias Funez, F.J. Burgos Revilla
Servicio de Urología, Hospital Universitario Ramón y Cajal, Instituto de Investigación Sanitaria IRYCIS, Madrid, Spain
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Tables (6)
Table 1. Selection criteria for patients undergoing ureterorenoscopy for the treatment of lithiasis.
Table 2. Criteria for sepsis, severe sepsis and septic shock according to International Sepsis Consensus Conference.
Table 3. Descriptive, clinical and microbiological characteristics of urinary sepsis after ureterorenoscopy.
Table 4. Analysis of medical history.
Table 5. Analysis of the clinical onset of lithiasis.
Table 6. Analysis of the endourological treatment and average stay.
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Abstract
Objective

To evaluate the incidence, clinical presentation and factors associated with the development of urinary sepsis after performing ureterorenoscopy.

Material and methods

Retrospective study of patients undergoing ureterorenoscopy for the treatment of lithiasis between July 2015 and October 2017. Patients who developed urinary sepsis during the 30 days following the intervention were identified. Personal, clinical, surgical and microbiological backgrounds were collected. Statistical analysis was performed with the Chi squared test (or Fisher's exact test), Student's t (or U Mann–Whitney) or logistic regression as appropriate.

Results

246 ureterorenoscopies were performed, 184 (74.8%) on ureteral stones and 62 (25.2%) on kidney stones, with a mean age of 52 (44.5–59.5) years. After procedure, 18 (7.3%) patients developed urinary sepsis, 10 of them (55.5%) occurred in the first 24h. The urine culture showed enterobacteria (61.1%) and enterococci (38.9%). The antibiogram showed greater sensitivity to nitrofurantoins (100%) and quinolones (72%). The statistical analysis showed that female sex, the clinical debut of urolithiasis as urinary sepsis, having received antibiotic or having required urinary diversion by a double J during debut, positive presurgical uroculture and the persistence of residual lithiasis after surgery were significantly associated (p<0.05) with the development of urinary sepsis after ureterorenoscopy.

Conclusion

Urinary sepsis is a complication that appears after performing ureterorenoscopy, especially in female patients with a history of urinary sepsis, antibiotic therapy, double J, previous positive urine culture or residual lithiasis after the procedure.

Keywords:
Ureterorenoscopy
Sepsis
Lithiasis
Resumen
Objetivo

Evaluar la incidencia, presentación clínica y factores asociados al desarrollo de sepsis urinaria tras la realización de una ureterorrenoscopia.

Material y métodos

Estudio retrospectivo de los pacientes intervenidos mediante ureterorrenoscopia para el tratamiento de la litiasis entre julio de 2015 y octubre de 2017. Se identificaron aquellos pacientes que desarrollaron sepsis urinaria en los primeros 30 días tras la intervención. Se recogieron antecedentes personales, clínicos, quirúrgicos y microbiológicos. Se realizó análisis estadístico mediante χ2 (o test exacto de Fisher), t de Student (o U de Mann-Whitney) o regresión logística según procediese.

Resultados

Se realizaron 246 ureterorrenoscopias, 184 (74,8%) sobre litiasis ureterales y 62 (25,2%) sobre litiasis renales, con una edad media de 52 (44,5-59,5) años. Tras el procedimiento, 18 (7,3%) pacientes desarrollaron sepsis urinaria, 10 de ellos (55,5%) en las primeras 24h. El urocultivo mostró enterobacterias (61,1%) y enterococos (38,9%). El antibiograma mostró mayor sensibilidad a nitrofurantoínas (100%) y a quinolonas (72%). El análisis estadístico mostró que el sexo femenino, el inicio clínico de la litiasis en forma de sepsis urinaria, haber recibido antibiótico o haber precisado derivación urinaria mediante doble J en el inicio, el urocultivo prequirúrgico positivo y la persistencia de restos litiásicos tras la cirugía se asociaron de forma significativa (p<0,05) al desarrollo de sepsis urinaria tras la ureterorrenoscopia.

Conclusión

La sepsis urinaria es una complicación que aparece tras la realización de una ureterorrenoscopia, especialmente en pacientes de sexo femenino, con antecedente de sepsis urinaria, antibioterapia, doble J, urocultivo previo positivo o presencia de restos litiásicos tras el procedimiento.

Palabras clave:
Ureteroscopia
Sepsis
Litiasis

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