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Predictors of emergency department attendance following ureterorenoscopy for urolithiasis

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Abstract

Background

We sought to determine the rate of emergency department (ED) attendance for complications after ureterorenoscopy (URS) for stone disease and to identify risk factors for ED attendance after URS.

Methods

An analysis of all patients undergoing URS over 12 months at a single institution was performed. Patient demographics, preoperative and intraoperative variables associated with postoperative complications and subsequent ED attendance were collected. Logistic regression analyses were performed to determine predictors of URS complications presenting to ED.

Results

In total, 202 ureteroscopies were performed on 142 patients for urolithiasis. The mean age was 50.73 ± 13.93 and 66% were male. The incidence of re-presentation to ED was 14.8% (n = 30). Patients presented with postoperative pain (n = 10; 4.95%), pyrexia (n = 9; 4.46%), urinary tract infection (UTI) (n = 7, 3.47%), haematuria (n = 3, 1.49%) and urosepsis (n = 1; 0.5%). Significant risk factors for ED attendance included preoperative stent dwell time > 30 days (P = 0.004), recently treated positive preoperative urine culture (P < 0.0001), stone size ≥ 13 mm (P = 0.043), stone location mid-ureter (P = 0.036) and female gender (P = 0.005). The following factors did not predict ED attendance, stent omission, access sheath utilization and operation duration.

Conclusion

Risk factors for ED attendance after URS include prolonged pre-stent dwell time, stone size ≥ 13 mm, treatment for a positive preoperative urine culture, mid-ureteric stone location and female gender. Urologists should be aware of these findings to decrease the risk of emergency re-presentation after elective URS surgery.

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Abbreviations

ED:

Emergency department

URS:

Ureterorenoscopy

UTI:

Urinary tract infection

References

  1. Bosquet E, Peyronnet B, Mathieu R, Khene ZE, Pradere B, Manunta A, Vincendeau S, Guille F, Bensalah K, Verhoest G (2017) Safety and feasibility of outpatient flexible ureteroscopy for urinary stones: a retrospective single-center study. Prog Urol 27(16):1043–1049

    Article  CAS  PubMed  Google Scholar 

  2. Bloom J, Matthews G, Phillips J (2016) Factors influencing readmission after elective Ureteroscopy. J Urol 195(5):1487–1491

    Article  PubMed  Google Scholar 

  3. Somani BK, Giusti G, Sun Y, Osther PJ, Frank M, De Sio M et al (2017) Complications associated with ureterorenoscopy (URS) related to treatment of urolithiasis: the Clinical Research Office of Endourological Society URS Global study. World J Urol 35(4):675–681

    Article  CAS  PubMed  Google Scholar 

  4. Bloom J, Fox C, Fullerton S, Matthews G, Phillips J (2017) Sepsis after elective ureteroscopy. Can J Urol 24(5):9017–9023

    PubMed  Google Scholar 

  5. Kandasami SV, Mamoulakis C, El-Nahas AR, Averch T, Tuncay OL, Rawandale-Patil A et al (2014) Impact of case volume on outcomes of ureteroscopy for ureteral stones: the clinical research office of the endourological society ureteroscopy global study. Eur Urol 66(6):1046–1051

    Article  PubMed  Google Scholar 

  6. Malik RD, Wu YR, Zimmern PE (2018) Definition of recurrent urinary tract infections in women: which one to adopt? Female Pelvic Med Reconstr Surg 24(6):424–429

    Article  PubMed  Google Scholar 

  7. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G, SCCM/ESICM/ACCP/ATS/SIS (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Crit Care Med 31(4):1250–1256

    Article  PubMed  Google Scholar 

  8. Lamb AD, Vowler SL, Johnston R, Dunn N, Wiseman OJ (2011) Meta-analysis showing the beneficial effect of alpha-blockers on ureteric stent discomfort. BJU Int 108(11):1894–1902

    Article  PubMed  Google Scholar 

  9. Wang CJ, Huang SW, Chang CH (2009) Effects of specific alpha-1A/1D blocker on lower urinary tract symptoms due to double-J stent: a prospectively randomized study. Urol Res 37(3):147–152

    Article  CAS  PubMed  Google Scholar 

  10. Nevo A, Mano R, Baniel J, Lifshitz DA (2017) Ureteric stent dwelling time: a risk factor for post-ureteroscopy sepsis. BJU Int 120(1):117–122

    Article  PubMed  Google Scholar 

  11. Perlmutter AE, Talug C, Tarry WF, Zaslau S, Mohseni H, Kandzari SJ (2008) Impact of stone location on success rates of endoscopic lithotripsy for nephrolithiasis. Urology. 71(2):214–217

    Article  PubMed  Google Scholar 

  12. Hollenbeck BK, Schuster TG, Faerber GJ, Wolf JS Jr (2001) Comparison of outcomes of ureteroscopy for ureteral calculi located above and below the pelvic brim. Urology. 58(3):351–356

    Article  CAS  PubMed  Google Scholar 

  13. Carlos EC, Peters CE, Wollin DA, Winship BB, Davis LG, Li J et al (2018) Psychiatric diagnoses and other factors associated with emergency department return within 30 days of ureteroscopy. J Urol

  14. Scales CD, Saigal CS, Hanley JM, Dick AW, Setodji CM, Litwin MS (2014) The impact of unplanned postprocedure visits in the management of patients with urinary stones. Surgery. 155(5):769–775

    Article  PubMed  Google Scholar 

  15. Buldu I, Tepeler A, Karatag T, Ozyuvali E, Elbir F, Yordam M, Unsal A (2016) Which factors affect the hospital re-admission and re-hospitalization after flexible ureterorenoscopy for kidney stone? World J Urol 34(9):1291–1295

    Article  PubMed  Google Scholar 

  16. Pais VM Jr, Smith RE, Stedina EA, Rissman CM (2016) Does omission of ureteral stents increase risk of unplanned return visit? A systematic review and meta-analysis. J Urol 196(5):1458–1466

    Article  PubMed  Google Scholar 

  17. Mittakanti HR, Conti SL, Pao AC, Chertow GM, Liao JC, Leppert JT, Elliott CS (2018) Unplanned emergency department visits and hospital admissions following ureteroscopy: do ureteral stents make a difference? Urology. 117:44–49

    Article  PubMed  Google Scholar 

  18. Knipper S, Tiburtius C, Gross AJ, Netsch C (2015) Is prolonged operation time a predictor for the occurrence of complications in ureteroscopy? Urol Int 95(1):33–37

    Article  PubMed  Google Scholar 

  19. Moses RA, Ghali FM, Pais VM Jr, Hyams ES (2016) Unplanned hospital return for infection following ureteroscopy-can we identify modifiable risk factors? J Urol 195(4 Pt 1):931–936

    Article  PubMed  Google Scholar 

  20. Alezra E, Lasselin J, Forzini T, Francois T, Viart L, Saint F (2016) Prognostic factors for severe infection after flexible ureteroscopy: clinical interest of urine culture the day before surgery? Prog Urol 26(1):65–71

    Article  CAS  PubMed  Google Scholar 

  21. Kliś R, Szymkowiak S, Madej A, Blewniewski M, Krześlak A, Forma E et al (2014) Rate of positive urine culture and double–J catheters colonization on the basis of microorganism DNA analysis. Cent European J Urol 67:81–85

    PubMed  PubMed Central  Google Scholar 

  22. Klis R, Korczak-Kozakiewicz E, Denys A, Sosnowski M, Rozanski W (2009) Relationship between urinary tract infection and self-retaining Double-J catheter colonization. J Endourol 23(6):1015–1019

    Article  PubMed  Google Scholar 

  23. Nevo A, Mano R, Schreter E, Lifshitz DA (2017) Clinical implications of stent culture in patients with indwelling ureteral stents prior to ureteroscopy. J Urol 198(1):116–121

    Article  PubMed  Google Scholar 

  24. Huang J, Zhao Z, AlSmadi JK, Liang X, Zhong F, Zeng T, Wu W, Deng T, Lai Y, Liu L, Zeng G, Wu W (2018) Use of the ureteral access sheath during ureteroscopy: a systematic review and meta-analysis. PLoS One 13(2):e0193600

    Article  PubMed  PubMed Central  Google Scholar 

  25. Lildal SK, Nørregaard R, Andreassen KH, Christiansen FE, Jung H, Pedersen MR et al (2017) Ureteral access sheath influence on the ureteral wall evaluated by cyclooxygenase-2 and tumor necrosis factor-α in a porcine model. J Endourol 31:307–313

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Connolly Hospital, Blanchardstown, Dublin 15, Ireland

    Eoin MacCraith, John O’Kelly, James Ryan, James C. Forde, Ijaz Cheema, Liza McLornan & Niall F. Davis

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  1. Eoin MacCraith
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  2. John O’Kelly
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  3. James Ryan
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  4. James C. Forde
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  5. Ijaz Cheema
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  6. Liza McLornan
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  7. Niall F. Davis
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Correspondence to Eoin MacCraith.

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MacCraith, E., O’Kelly, J., Ryan, J. et al. Predictors of emergency department attendance following ureterorenoscopy for urolithiasis. Ir J Med Sci 189, 1445–1449 (2020). https://doi.org/10.1007/s11845-020-02221-7

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  • DOI: https://doi.org/10.1007/s11845-020-02221-7

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