title: Clinical outcomes after ureteroscopic lithotripsy in patients who initially presented with urosepsis: matched pair comparison with elective ureteroscopy.
abstract: OBJECTIVE
  The outcomes of ureteroscopy (URS) after urgent decompression and antibiotics for patients who initially present with urosepsis because of 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 with 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 three parameters (age, sex, and race) to compare outcomes and complications between 69 patients who had sepsis vs a matched cohort who did not have sepsis before URS.
  
  
  RESULTS
  The study included 138 patients, 88 (64%) females and 50 (36%) males with a median age of 57.5 years (range 18-88 years). Patients with previous sepsis had similar patient characteristics and stone-free rates (81% vs 77%) compared with patients without previous sepsis (P>0.05). Patients with previous sepsis, however, had a significantly higher complications rate (20% vs 7%), longer hospital length of stay (LOS), and longer courses of postoperative antibiotics after URS (P<0.05). Sepsis developed postoperatively in two patients with diabetes (one with and one without previous sepsis), and postoperative fever developed in five patients with previous sepsis.
  
  
  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.
authors.affiliation: Division of Urology, Comprehensive Kidney Stone Center, Duke University Medical Center , Durham, North Carolina.
authors.forename: Ramy F
authors.initials: RF
authors.lastname: Youssef
authors.forename: Andreas
authors.initials: A
authors.lastname: Neisius
authors.forename: Zachariah G
authors.initials: ZG
authors.lastname: Goldsmith
authors.forename: Momin
authors.initials: M
authors.lastname: Ghaffar
authors.forename: Matvey
authors.initials: M
authors.lastname: Tsivian
authors.forename: Richard H
authors.initials: RH
authors.lastname: Shin
authors.forename: Fernando
authors.initials: F
authors.lastname: Cabrera
authors.forename: Michael N
authors.initials: MN
authors.lastname: Ferrandino
authors.forename: Charles D
authors.initials: CD
authors.lastname: Scales
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Preminger
authors.forename: Michael E
authors.initials: ME
authors.lastname: Lipkin
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008096:Lithotripsy; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D018805:Sepsis / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000150:complications / Q000601:surgery*; D053039:Ureterolithiasis / Q000150:complications / Q000601:surgery*; D018666:Ureteroscopy; D014552:Urinary Tract Infections / Q000209:etiology / Q000628:therapy*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents