Do Patients Undergoing Primary Ureteroscopy For Ureteral Stones Have A Lower Post-Operative Sepsis Rate Compared To Those Previously Stented?

You have accessJournal of UrologyStone Disease: Surgical Therapy VI1 Apr 2018MP89-11 DO PATIENTS UNDERGOING PRIMARY URETEROSCOPY FOR URETERAL STONES HAVE A LOWER POST-OPERATIVE SEPSIS RATE COMPARED TO THOSE PREVIOUSLY STENTED? Nina Mikkilineni, Benjamin Muller, Gen Li, Gina Badalato, Sven Wenske, David Weiner, and Ojas Shah Nina MikkilineniNina Mikkilineni More articles by this author , Benjamin MullerBenjamin Muller More articles by this author , Gen LiGen Li More articles by this author , Gina BadalatoGina Badalato More articles by this author , Sven WenskeSven Wenske More articles by this author , David WeinerDavid Weiner More articles by this author , and Ojas ShahOjas Shah More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2951AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recently, primary ureteroscopy (PU) has been advocated over preoperative stenting when possible due to fewer procedures for the patient, shorter duration of irritative stent symptoms, and perhaps a decreased infection risk. We hypothesized that preoperative stenting has a higher risk of postoperative sepsis compared to PU. METHODS We retrospectively reviewed all patients with ICD9/ICD10 codes for ureteral stones (592.1, N20.1) from 10/2013 to 10/2017 at our institution. Only patients with procedure codes for ureteroscopy with lithotripsy (URSLL, CPT 52353/52356) were included. Patients were categorized as pre-stented for infection, pre-stented for non-infection, stented for 2nd stage URS, or PU. Time from stent placement to URSLL was recorded. Patient variables included age, gender, body mass index (BMI), and diabetes (DM). Outcome was immediate postop sepsis based on accepted criteria. Chi square/Fisher exact, Mann-Whitney, ANOVA, and multivariable logistic regression analyses were performed. RESULTS 420 patients met inclusion criteria. 63 patients (15%) were pre-stented/infected, 128 (30%) pre-stented/non-infected, 41 (10%) stented/2nd stage and 188 (45%) had PU. The average age was 53.2 years. 201 patients (48.1%) were female, however 68.2% of patients in the pre-stented/infected group were female (p<0.001). The average BMI was 28.2 and 76 patients (18.1%) had DM. Overall, 7 patients (1.7%) became septic postop. There was no difference in sepsis rate between PU and all pre-stented patients (1.1% vs 2.6%, p=0.45). Comparing PU to pre-stented/non-infected patients (1.1% vs 1.6% p=1.0), to pre-stented/infected (1.1% vs 4.8% p=0.10), and to stented/2nd stage (1.1% vs 0% p=1.0), sepsis rates were not significantly different. There was no significant difference in sepsis rate between pre-stented/infected vs pre-stented/non-infected patients (4.8% vs 1.6%, p=0.33). The average stent time was 30.9 vs 37.4 days for infected and non-infected patients, respectively (p= 0.04). The average stent time for stented/2nd stage was 18.3 days. On multivariate analysis including patient group, stent duration, age, gender, BMI, and DM, only higher BMI was borderline associated with lower sepsis rate (OR 0.84, CI 0.67,1.0 p=0.07). CONCLUSIONS Our data suggests no significant difference in postoperative sepsis rate between PU and pre-stenting, regardless of preoperative stent indication. On multivariate analysis, neither pre-stenting, PU, nor stent duration were factors predictive of postoperative sepsis. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1210 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Nina Mikkilineni More articles by this author Benjamin Muller More articles by this author Gen Li More articles by this author Gina Badalato More articles by this author Sven Wenske More articles by this author David Weiner More articles by this author Ojas Shah More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...