Presentation Authors: Wen Zhong*, Guohua Zeng, Guangzhou, China, People's Republic of
Introduction: To evaluate the risk factors of systemic inflammatory response syndrome (SIRS) following retrograde intrarenal surgery (RIRS).
Methods: A total of 260 patients who underwent RIRS were included in this retrospective study. 21 out of 260 patients who developed postoperative SIRS were categorized as SIRS group and the rest 239 patients were categorized as non-SIRS group. Two-tailed t-test was used to determine significance of change in continuous variables whereas categorical data were compared with the Chi-squared test or Fisherâ€™s exact test for proportions. Multivariable logistic regression analysis was performed to identify the potential risk factors of SIRS as after adjusting for covariates that were statistically significant in the univariate analysis.
Results: 157 (60.4%) patients were males, and 103(39.6%) patients were females. The mean age was 48.4Â±12.2 years and the mean stone burden was 1.7Â±0.7 cm. Preoperative positive midstream urine culture was noted in 47(18.1%ï¼‰patients and solitary kidney was found in 31(11.9%) patients. The mean lithotripsy time was 34.3Â±13.0 minutes and the mean operation time was 45.4Â±12.9 minutes. Twenty one (8.1%) patients developed postoperative SIRS. Two patients developed clinical septic shock and recovered after treatment in intensive care unit (ICU). Multivariable logistic regression analysis showed that sex (OR=0.047ï¼Œ95%CI=0.009-0.238, pï¼œ0.001), irrigation method (OR=0.059, 95%CI=0.008-0.446ï¼Œp=0.006), access sheath (OR=0.200, 95%CI=0.045-0.878,p=0.033), infection stone (OR=3.769, 95%CI=0.829-17.134, p=0.086), stone burden (OR=2.789ï¼Œ95%CI=0.761-10.225ï¼Œp=0.122), irrigation flow rate (OR=1.240, 95%CI=1.137-1.352, pï¼œ0.001), and lithotripsy time (OR=0.935, 95%CI=0.856-1.021, p=0.133) were identified as independent risk factors of SIRS after RIRS. The equation was: LogitP=-9.404-3.050*Sex-2.826*(Irrigation method)-1.611*(Access sheath)+1.327* (Infection stone) +1.026*(Stone burden)+0.215*(Irrigation flow rate)-0.068*(Lithotripsy time).
Conclusions: Females, infection stone, large stone burden, irrigation with high flow rate, small size access sheath and prolonged operation time were important risk factors of SIRS after RIRS. Syringe injection was regarded as a good method to provide irrigation with low flow rate and low pressure, and larger size access sheath can provide better drainage during RIRS, therefore to be preferred for RIRS procedures. The operation time should be seriously controlled in patients with high risk factors for SIRS, and staged procedures strategy should be preferred.