[Prognostic factors for severe infection after flexible ureteroscopy: Clinical interest of urine culture the day before surgery?].
OBJECTIVE
The objectives of this study have been to determine prognostic factors for acute pyelonephritis (AP) after flexible ureteroscopy (FU), to assess the frequency of readmission for AP and to study the usefulness of urinalysis the day before surgery.


METHODS
Between 2010 and 2013, 266 patients have had at least one ureteroscopy (n=325). All infectious complications and unplanned readmissions within the month after FU were retrospectively evaluated. Several data have been collected: age, sex, BMI, surgical indication (calculis or tumor), number of previous ureteroscopies, number of previous surgeries for calculis, stones number, size and location, bilateral interventions, operating time, preoperative ureteral stenting, postoperative stenting, hospitalization stay, urine culture the day before surgery (j-1) and prescription of antibiotic therapy the week before FU. Correlation between these variables and acute pyelonephritis (AP) the month following the USSR was tested (StatView 4.5, SAS Institute) (P<0.05 significant).


RESULTS
We observed 24 postoperative APs (7.4%), 17 prior to hospital discharge and 7 requiring rehospitalization. In univariate analysis, the significant prognostic factors of postoperative AP have been: stone size (>14 mm) (P=0.03); operating time (70 minutes) (P<0.005); positive day - 1 urine culture (P<0.001); antibiotics treatment the week before FU (P<0.001). In multivariate analysis, antibiotics prescription during the week before USSR remained significant (P<0.002; RR 5.8 [1.9-15]).


CONCLUSIONS
Acute pyelonephritis requiring unplanned admission after ureteroscopy is a rare complication (2.4%). Urinalysis one day before ureteroscopy could allow early antibiotic therapy and may reduce 63% of unplanned hospital admissions for acute pyelonephritis.


METHODS
5.
HERVI EA 3801, service d'urologie-transplantation, université de Picardie Jules-Verne, CHU d'Amiens, avenue R.-Laennec, 80054 Amiens cedex 1, France. Electronic address: eric_alezra@hotmail.fr.
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E
Alezra
HERVI EA 3801, service d'urologie-transplantation, université de Picardie Jules-Verne, CHU d'Amiens, avenue R.-Laennec, 80054 Amiens cedex 1, France.
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Lasselin
HERVI EA 3801, service d'urologie-transplantation, université de Picardie Jules-Verne, CHU d'Amiens, avenue R.-Laennec, 80054 Amiens cedex 1, France; HeRVI EA 3801, laboratoire de recherche, université de Picardie Jules-Verne, CHU d'Amiens, 80054 Amiens, France.
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Forzini
HERVI EA 3801, service d'urologie-transplantation, université de Picardie Jules-Verne, CHU d'Amiens, avenue R.-Laennec, 80054 Amiens cedex 1, France.
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T
François
HERVI EA 3801, service d'urologie-transplantation, université de Picardie Jules-Verne, CHU d'Amiens, avenue R.-Laennec, 80054 Amiens cedex 1, France; Laboratoire d'anatomie et d'organogénèse, université de Picardie Jules-Verne, CHU d'Amiens, 80054 Amiens, France.
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Viart
HERVI EA 3801, service d'urologie-transplantation, université de Picardie Jules-Verne, CHU d'Amiens, avenue R.-Laennec, 80054 Amiens cedex 1, France; HeRVI EA 3801, laboratoire de recherche, université de Picardie Jules-Verne, CHU d'Amiens, 80054 Amiens, France; Biobanque de Picardie, université de Picardie Jules-Verne, CHU d'Amiens, 80054 Amiens, France.
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Saint
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011379:Prognosis; D011704:Pyelonephritis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology* / Q000382:microbiology; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D020709:Ureteroscopes / Q000009:adverse effects*; D018666:Ureteroscopy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D014545:Urinary Calculi / Q000628:therapy
D000900:Anti-Bacterial Agents
Flexible ureteroscopy; Pyélonéphrite; Readmission rate; Réhospitalisation; Ureteroscopy; Urinary tract infection (UTI); Urétéroscopie; Urétéroscopie souple