CLINICAL OUTCOMES AFTER URETEROSCOPIC LITHOTRIPSY IN PATIENTS WHO INITIALLY PRESENTED WITH UROSEPSIS: MATCHED PAIR COMPARISON TO ELECTIVE URETEROSCOPY.
OBJECTIVES: The outcomes of ureteroscopy (URS) after urgent decompression and antibiotics for patients who initially present with urosepsis due to obstructive urolithiasis have not been previously evaluated. The aim of this study was to compare the outcomes and complications of URS in patients with a recent history of sepsis in comparison to those without sepsis. METHODS: The study included 138 patients who underwent URS for stone removal from January 2004 to September 2011 at a university medical center. A matched-pair analysis was performed using 3 parameters (age, gender and race) to compare outcomes and complications between 69 patients who had sepsis versus a matched cohort who did not have sepsis prior to URS. RESULTS: The study included 138 patients, 88 females (64%) and 50 males (36%) with median age 57.5 (range, 18-88). Patients with prior sepsis had similar patient characteristics and stone free rates (81% vs 77%) compared to patients without prior sepsis (p > 0.05). However, patients with prior sepsis had a significantly higher complications rate (20% vs 7%), longer length of hospital stay (LOS) and longer courses of postoperative antibiotics after URS (p < 0.05). Two diabetic patients developed sepsis postoperatively (1 with and 1 without prior sepsis) and 5 patients with prior sepsis developed postoperative fever. CONCLUSIONS: URS after decompression for urolithiasis related sepsis has similar success but higher complication rates, greater LOS and longer course of postoperative antibiotics. This is important in counseling patients who present for definitive URS after urgent decompression for urolithiasis related sepsis. .
Youssef, R; Neisius, A; Goldsmith, Z; Ghaffar, M; Tsivian, M; Shin, R; Cabrera, F; Ferrandino, MN; Scales, CD; Preminger, GM; Lipkin, ME
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