https://doi.org/10.4081/aiua.2022.1.97
Infectious complications of endourological treatment of kidney stones: A meta-analysis of randomized clinical trials
Published: March 29, 2022
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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Objective: Endourological treatment is associated with a risk of postoperative febrile urinary tract infections and sepsis. The aim of this study was to review the reported rate of infectious complications in relation to the type and modality of the endourologic procedure.
Methods: This systematic review was conducted in accordance with the PRISMA guidelines. Two electronic databases (PubMed and EMBASE) were searched. Out of 243 articles retrieved we included 49 studies after full-text evaluation.
Results: Random-effects meta-analysis demonstrated that retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) were associated with not significantly different odds of getting fever (OR = 1.54, 95% CI: 0.99 to 2.39; p = 0.06) or sepsis (OR = 1.52, 95% CI: 0.37 to 6.20, p = 0.56). The odds of getting fever were not significantly different for mini PCNL compared to standard PCNL (OR = 1.11, 95% CI: 0.85 to 1.44; p = 0.45) and for tubeless PCNL compared to standard PCNL (OR = 1.34 95% CI: 0.61 to 2.91, p = 0.47). However, the odds for fever after PCNL with suctioning sheath were lower than the corresponding odds for standard PCNL (OR = 0.37, 95% CI: 0.20 to 0.70, p = 0.002). The odds of getting fever after PCNL with perioperative prophylaxis were not different from the corresponding odds after PCNL with perioperative prophylaxis plus a short oral antibiotic course (before or after the procedure) (OR = 1.31, 95% CI: 0.71 to 2.39, p = 0.38).
Conclusions: The type of endourological procedure does not appear to be decisive in the onset of infectious complications, although the prevention of high intrarenal pressure during the procedure could be crucial in defining the risk of infectious complications.
on behalf of U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai
Kim DS, Yoo KH, Jeon SH, Lee SH. Risk factors of febrile urinary tract infections following retrograde intrarenal surgery for renal stones. Medicine (Baltimore). 2021; 100:e25182.
DOI: https://doi.org/10.1097/MD.0000000000025182
Fan S, Gong B, Hao Z, et al. Risk factors of infectious complications following flexible ureteroscope with a holmium laser: a retrospective study. Int J Clin Exp Med 2015; 8:11252-9.
Zhong W, Leto G, Wang L, et al. Systemic inflammatory response syndrome after flexible ureteroscopic lithotripsy: a study of risk factors. J Endourol 2015; 29:25-8.
DOI: https://doi.org/10.1089/end.2014.0409
Berardinelli F, De Francesco P, Marchioni M, et al. Infective complications after retrograde intrarenal surgery: a new standardized classification system. Int Urol Nephrol. 2016; 48:1757-1762.
DOI: https://doi.org/10.1007/s11255-016-1373-1
Dybowski B, Bres-Niewada E, Rzeszutko M, et al. Risk factors for infectious complications after retrograde intrarenal surgery - a systematic review and narrative synthesis. Cent European J Urol. 2021;74:437-445.
Michel MS, Trojan L, Rassweiler JJ. Complications in percutaneous nephrolithotomy. Eur Urol. 2007; 51:899-906.
DOI: https://doi.org/10.1016/j.eururo.2006.10.020
Rivera M, Viers B, Cockerill P, et al. Pre- and postoperative predictors of infection-related complications in patients undergoing percutaneous nephrolithotomy. J Endourol. 2016; 30:982-6.
DOI: https://doi.org/10.1089/end.2016.0191
de la Rosette J, Assimos D, Desai M, et al. The clinical research office of the endourological society percutaneous nephrolithotomy global study: Indications, complications, and outcomes in 5803 patients. J Endourol. 2011; 25:11-7.
DOI: https://doi.org/10.1089/end.2010.0424
Kumar GM, Nirmal KP, Kumar GS. Postoperative infective complications following percutaneous nephrolithotomy. Urol Ann. 2021;13:340-345.
DOI: https://doi.org/10.4103/UA.UA_153_20
Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6:e1000097.
DOI: https://doi.org/10.1371/journal.pmed.1000097
Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992; 101:1644-55.
DOI: https://doi.org/10.1378/chest.101.6.1644
Singer M, Deutschman CS, Seymour CW, et al. 292 The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315: 801-10.
DOI: https://doi.org/10.1001/jama.2016.0287
Sterne JAC, Savovic J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019; 366:l4898.
DOI: https://doi.org/10.1136/bmj.l4898
Agrawal MS, Mishra D. Minimally-invasive percutaneous nephrolithotomy versus retrograde intrarenal surgery for treatment of medium sized (10-20 mm) renal calculi-a prospective study J Endourol 2016; 30 (Supplement 2):A204-A205.
Fayad AS, Elsheikh MG, Ghoneima W. Tubeless mini-percutaneous nephrolithotomy versus retrograde intrarenal surgery for lower calyceal stones of ≤ 2 cm: A prospective randomised controlled study. Arab J Urol 2017; 15: 36-41.
DOI: https://doi.org/10.1016/j.aju.2016.10.002
Gu XJ, Lu JL, Xu Y. Treatment of large impacted proximal ureteral stones: randomized comparison of minimally invasive percutaneous antegrade ureterolithotripsy versus retrograde ureterolithotripsy. World J Urol. 2013;31:1605-1610.
DOI: https://doi.org/10.1007/s00345-013-1026-2
Jain M, Manohar C, Nagabhushan M, Keshavamurthy R. A comparative study of minimally invasive percutaneous nephrolithotomy and retrograde intrarenal surgery for solitary renal stone of 1-2 cm Urol Ann 2021; 13:226-231.
DOI: https://doi.org/10.4103/UA.UA_10_20
Jiang K, Chen H, Yu X, et al. The “all-seeing needle” micro-PCNL versus flexible ureterorenoscopy for lower calyceal stones of ≤ 2 cm. Urolithiasis 2019; 47:201-206
DOI: https://doi.org/10.1007/s00240-018-1049-7
Jin L, Yang B, Zhou Z, Li N. Comparative efficacy on flexible ureteroscopy lithotripsy and miniaturized percutaneous nephrolithotomy for the treatment of medium-sized lower-pole renal calculi. J Endourol. 2019;33:914-919.
DOI: https://doi.org/10.1089/end.2019.0504
Kumar A, Kumar N, Vasudeva P, et al. A prospective, randomized comparison of shock wave lithotripsy, retrograde intrarenal surgery and miniperc for treatment of 1 to 2 cm radiolucent lower calyceal renal calculi: a single center experience. J Urol. 2015;193:160-164.
DOI: https://doi.org/10.1016/j.juro.2014.07.088
Lee JW, Park J, Lee SB, et al. Mini-percutaneous nephrolithotomy vs retrograde intrarenal surgery for renal stones larger than 10 mm: a prospective randomized controlled trial. Urology 2015;86:873-877.
DOI: https://doi.org/10.1016/j.urology.2015.08.011
Li JW, Wang F, Cai FZ, Gao HZ. Staged retrograde flexible ureteroscopic lithotripsy versus miniaturized percutaneous nephrolithotomy for renal stones of 2-4 cm in diameter: a randomized controlled trial. Nan Fang Yi Ke Da Xue Xue Bao. 2016;36:1672-1676.
Mhaske S, Singh M, Mulay A, et al. Miniaturized percutaneous nephrolithotomy versus retrograde intrarenal surgery in the treatment of renal stones with a diameter < 15 mm: A 3-year open-label prospective study. Urol Ann. 2018; 10:165-169.
DOI: https://doi.org/10.4103/UA.UA_156_17
Oo SM. Outcomes of minipercutaneous nephrolithotomy versus retrograde intrarenal surgery in lower pole renal stone. Int J Urol. 2020; 27(Suppl 1):40.
Sabnis RB, Ganesamoni R, Doshi A, et al. Micropercutaneous nephrolithotomy (microperc) vs retrograde intrarenal surgery for the management of small renal calculi: a randomized controlled trial. BJU Int. 2013;112:355-61.
DOI: https://doi.org/10.1111/bju.12164
Wen J, Xu G, Du C, Wang B. Minimally invasive percutaneous nephrolithotomy versus endoscopic combined intrarenal surgery with flexible ureteroscope for partial staghorn calculi: A randomised controlled trial. Int J Surg. 2016; 28:22-27.
DOI: https://doi.org/10.1016/j.ijsu.2016.02.056
Zeng G, Zhang T, Agrawal M, et al. Super-mini percutaneous nephrolithotomy (SMP) vs retrograde intrarenal surgery for the treatment of 1-2 cm lower-pole renal calculi: an international multicentre randomised controlled trial. BJU International. 2018;122:1034-1040.
DOI: https://doi.org/10.1111/bju.14427
Zhang H, Hong TY, Li G, et al. Comparison of the efficacy of ultra-mini PCNL, flexible ureteroscopy, and shock wave lithotripsy on the treatment of 1-2 cm lower pole renal calculi. Urol Int. 2019;102:153-159.
DOI: https://doi.org/10.1159/000493508
Agrawal M, Mishra D. Minimally-invasive percutaneous nephrolithotomy versus conventional percutaneous nephrolithotomy for treatment of large sized (20-30 mm) renal calculi-a prospective study. J Endourol. 2018;32(Suppl2):A59-A60.
Bozzini G, Aydogan TB, Müller A, et al. A comparison among PCNL, Miniperc and Ultraminiperc for lower calyceal stones between 1 and 2 cm: A prospective, comparative, multicenter and randomised study. BMC Urology. 2020; 20:1.
DOI: https://doi.org/10.1186/s12894-020-00636-z
Cheng F, Yu W, Zhang X, et al. Minimally invasive tract in percutaneous nephrolithotomy for renal stones. J Endourol. 2010;24:1579-82.
DOI: https://doi.org/10.1089/end.2009.0581
Guddeti RS, Hegde P, Chawla A, et al. Super-mini percutaneous nephrolithotomy (PCNL) vs standard PCNL for the management of renal calculi of < 2 cm: a randomised controlled study. BJU Int. 2020;126:273-279.
DOI: https://doi.org/10.1111/bju.15144
Güler A, Erbin A, Ucpinar B, et al. Comparison of miniaturized percutaneous nephrolithotomy and standard percutaneous nephrolithotomy for the treatment of large kidney stones: a randomized prospective study. Urolithiasis. 2019; 47:289-295.
DOI: https://doi.org/10.1007/s00240-018-1061-y
Sakr A, Salem E, Kamel M, et al. Minimally invasive percutaneous nephrolithotomy vs standard PCNL for management of renal stones in the flank-free modified supine position: single-center experience. Urolithiasis. 2017;45:585-589.
DOI: https://doi.org/10.1007/s00240-017-0966-1
Tepeler A, Akman T, Silay MS, et al. Comparison of intrarenal pelvic pressure during micro-percutaneous nephrolithotomy and conventional percutaneous nephrolithotomy. Urolithiasis. 2014; 42:275-279.
DOI: https://doi.org/10.1007/s00240-014-0646-3
Zeng G, Cai C, Duan X, et al. Mini percutaneous nephrolithotomy is a noninferior modality to standard percutaneous nephrolithotomy for the management of 20-40 mm renal calculi: a multicenter randomized controlled trial. Eur Urol. 2021; 79:114-121.
DOI: https://doi.org/10.1016/j.eururo.2020.09.026
Sabnis R., Ganpule A., Desai M. Is there any rationale of preferring ultraminiperc (MIP S) over miniperc (MIP M)?Prospective randomized study. J Endourol. 2016; 30(Suppl2):A376-A377.
Agrawal MS, Agrawal M, Gupta A, et al. A randomized comparison of tubeless and standard percutaneous nephrolithotomy. J Endourol. 2008; 22:439-442.
DOI: https://doi.org/10.1089/end.2007.0118
Bhat S, Lal J, Paul F. A randomized controlled study comparing the standard, tubeless, and totally tubeless percutaneous nephrolithotomy procedures for renal stones from a tertiary care hospital Indian J Urol. 2017;33:310-314.
DOI: https://doi.org/10.4103/iju.IJU_52_17
Istanbulluoglu MO, Ozturk B, Gonen M, et al. Effectiveness of totally tubeless percutaneous nephrolithotomy in selected patients: A prospective randomized study. Int Urol Nephrol. 2009; 41:541-545.
DOI: https://doi.org/10.1007/s11255-008-9517-6
Lu Y, Ping J-G, Zhao X-J, et al. Randomized prospective trial of tubeless versus conventional minimally invasive percutaneous nephrolithotomy. World J Urol. 2013; 31:1303-1307.
DOI: https://doi.org/10.1007/s00345-012-0921-2
Mishra S, Sabnis RB, Kurien A, et al. Questioning the wisdom of tubeless percutaneous nephrolithotomy (PCNL): a prospective randomized controlled study of early tube removal vs tubeless PCNL. BJU Int. 2010; 106:1045-8.
DOI: https://doi.org/10.1111/j.1464-410X.2010.09223.x
Moosanejad N, Firouzian A, Hashemi SA, et al. Comparison of totally tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy for kidney stones: A randomized, clinical trial. Braz J Med Biol Res. 2016; 49:e4878.
DOI: https://doi.org/10.1590/1414-431X20154878
Shah HN, Hegde S, Shah JN, et al. A prospective, randomized trial evaluating the safety and efficacy of fibrin sealant in tubeless percutaneous nephrolithotomy. J Urol 2006; 176:2488-2493.
DOI: https://doi.org/10.1016/j.juro.2006.07.148
Titaram S, Nualyong C, Taweemonkongsap T, et al. The impact of gelatin-sealant in the access tract after tubeless percutaneous nephrolithotomy: A randomized controlled trial. J Med Ass Thai. 2017; 100(Suppl2):S132-S137.
Mankongsrisuk T, Nualyong C, Tantiwong A, et al. Efficacy of nephrostomy tract infiltration with bupivacaine before and after tubeless percutaneous nephrolithotomy: A randomized control study. J Med Ass Thai 2017; 100(Suppl2):S138-S143.
Huang J, Song L, Xie D, et al. A Randomized Study of Minimally Invasive Percutaneous Nephrolithotomy (MPCNL) with the aid of a patented suctioning sheath in the treatment of renal calculus complicated by pyonephrosis by one surgery. BMC Urol. 2016; 16:71.
DOI: https://doi.org/10.1186/s12894-016-0184-0
Lai D, Xu W, Chen M, et al. Minimally invasive percutaneous nephrolithotomy with a novel vacuum-assisted access sheath for obstructive calculous pyonephrosis: a randomized study. Urol J. 2020; 17:474-479.
Zhong W, Wen J, Peng L, Zeng G. Enhanced super-mini-PCNL (eSMP): low renal pelvic pressure and high stone removal efficiency in a prospective randomized controlled trial. World J Urol. 2021; 39:929-934.
DOI: https://doi.org/10.1007/s00345-020-03263-3
Eisner B, Agrawal S, Desai M, et al. Initial human experience with a novel stone aspiration device used during ureteroscopic lithotripsy for renal stones. J Urol. 2020; 203(Suppl4):e211.
DOI: https://doi.org/10.1097/JU.0000000000000840.017
Sur RL, Krambeck AE, Large T, et al. A randomized controlled trial of preoperative prophylactic antibiotics for percutaneous nephrolithotomy in moderate to high infectious risk population: a report from the EDGE consortium. J Urol. 2021; 205:1379-1386.
DOI: https://doi.org/10.1097/JU.0000000000001582
Bag S, Kumar S, Taneja N, et al. One week of nitrofurantoin before percutaneous nephrolithotomy significantly reduces upper tract infection and urosepsis: A prospective controlled study. Urology. 2011; 77:45-49.
DOI: https://doi.org/10.1016/j.urology.2010.03.025
Chew BH, Miller NL, Abbott JE, et al. A randomized controlled trial of preoperative prophylactic antibiotics prior to percutaneous nephrolithotomy in a low infectious risk population: a report from the EDGE consortium. J Urol. 2018; 200:801-808.
DOI: https://doi.org/10.1016/j.juro.2018.04.062
Dogan HS, Sahin A, Cetinkaya Y, et al. Antibiotic prophylaxis in percutaneous nephrolithotomy: prospective study in 81 patients. J Endourol. 2002; 16:649-653.
DOI: https://doi.org/10.1089/089277902761402989
Mariappan P, Smith G, Moussa SA, Tolley DA. One week of ciprofloxacin before percutaneous nephrolithotomy significantly reduces upper tract infection and urosepsis: a prospective controlled study. BJU Int. 2006; 98:1075-9.
DOI: https://doi.org/10.1111/j.1464-410X.2006.06450.x
Tuzel E, Aktepe OC, Akdogan B. Prospective comparative study of two protocols of antibiotic prophylaxis in percutaneous nephrolithotomy. J Endourol. 2013; 27:172-6.
DOI: https://doi.org/10.1089/end.2012.0331
Song F, Liu C, Zhang J, et al. Antibacterial effect of Fosfomycin tromethamine on the bacteria inside urinary infection stones. Int Urol Nephrol. 2020; 52:645-654.
DOI: https://doi.org/10.1007/s11255-019-02358-0
Seyrek M, Binbay M, Yuruk E, et al. Perioperative prophylaxis for percutaneous nephrolithotomy: randomized study concerning the drug and dosage. J Endourol. 2012; 26:1431-6.
DOI: https://doi.org/10.1089/end.2012.0242
Taken K., Asik A., Eryilmaz R., et al. Comparison of ceftriaxone and cefazolin sodium antibiotic prophylaxis in terms of SIRS/urosepsis rates in patients undergoing percutaneous nephrolithotomy. J Urol Surg. 2019; 6:111-117.
DOI: https://doi.org/10.4274/jus.galenos.2018.2367
Demirtas A, Yildirim YE, Sofikerim M, et al. Comparison of infection and urosepsis rates of ciprofloxacin and ceftriaxone prophylaxis before percutaneous nephrolithotomy: a prospective and randomised study. Scientific World Journal. 2012; 2012:916381.
DOI: https://doi.org/10.1100/2012/916381
Fourcade RO. Antibiotic prophylaxis with cefotaxime in endoscopic extraction of upper urinary tract stones: a randomized study. The Cefotaxime Cooperative Group. J Antimicrob Chemother. 1990;26(suppl A):77-83.
DOI: https://doi.org/10.1093/jac/26.suppl_A.77
Zhao Z, Fan J, Sun H, et al. Recommended antibiotic prophylaxis regimen in retrograde intrarenal surgery: evidence from a randomised controlled trial. BJU Int. 2019; 124:496-503.
DOI: https://doi.org/10.1111/bju.14832
Türk C, Neisius A, Petrík A, et al. EAU Guidelines on Urolithiasis. Retrieved from: https://uroweb.org/guidelines/urolithiasis/ Accessed on 30th December 2021.
Zheng C, Xiong B, Wang H, et al. Retrograde intrarenal surgery versus percutaneous nephrolithotomy for treatment of renal stones >2 cm: a meta-analysis. Urol Int. 2014; 93:417-24.
DOI: https://doi.org/10.1159/000363509
Chen Y, Wen Y, Yu Q, et al. Percutaneous nephrolithotomy versus flexible ureteroscopic lithotripsy in the treatment of upper urinary tract stones: a meta-analysis comparing clinical efficacy and safety. BMC Urol. 2020; 20:109.
DOI: https://doi.org/10.1186/s12894-020-00677-4
Tokas T, Skolarikos A, Herrmann TRW, Nagele U; Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group. Pressure matters 2: intrarenal pressure ranges during upper-tract endourological procedures. World J Urol. 2019; 37:133-142.
DOI: https://doi.org/10.1007/s00345-018-2379-3
Mrkobrada M, Ying I, Mokrycke S, et al. CUA Guidelines on antibiotic prophylaxis for urologic procedures. Can Urol Assoc J. 2015; 9:13-22.
DOI: https://doi.org/10.5489/cuaj.2382
Gravas S,, et al. Postoperative infection rates in low risk patients undergoing percutaneous nephrolithotomy with and without antibiotic prophylaxis: a matched case control study. J Urol. 2012; 188:843-7.
DOI: https://doi.org/10.1016/j.juro.2012.05.007
Chew BH, Flannigan R, Kurtz M, et al. A single dose of intraoperative antibiotics is sufficient to prevent urinary tract infection during ureteroscopy. J Endourol. 2016; 30:63-8.
DOI: https://doi.org/10.1089/end.2015.0511
How to Cite
Bapir, R. ., Bhatti, K. H. ., Eliwa, A. ., García-Perdomo, H. A. ., Gherabi, N. ., Hennessey, D. ., Mourmouris, P. ., Ouattara, A. ., Perletti, G. ., Philipraj, J. ., Trinchieri, A. ., & Buchholz, N. . (2022). Infectious complications of endourological treatment of kidney stones: A meta-analysis of randomized clinical trials. Archivio Italiano Di Urologia E Andrologia, 94(1), 97–106. https://doi.org/10.4081/aiua.2022.1.97
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