title: Infective complications after retrograde intrarenal surgery: a new standardized classification system.
abstract: OBJECTIVE
  Retrograde intrarenal surgery (RIRS) is considered a safe procedure; however, infective complications are potentially serious postoperative complications. The aim of this multicentre study was to evaluate prospectively the prevalence of infective complications after RIRS and identify risk factors.
  
  
  METHODS
  Baseline data were collected, and patients were questioned regarding postoperative infective complications following RIRS. The Fisher exact test, Student t test, Mann-Whitney U test, and multivariate regression analysis were used for data analysis.
  
  
  RESULTS
  A total of 403 patients from five European centers were included. Antibiotic prophylaxis was administered prior to RIRS in 100 %. Infection complications were recorded in 31 patients (7.7 %), consisting of fever in 18 (4.4 %), SIRS in 7 (1.7), and sepsis in 3 (0.7 %). Three required hospitalization for non-obstructive pyelonephritis (0.7 %). Univariate analysis revealed that coronary heart disease, chronic kidney disease, alteration of lipid metabolism, anticoagulant therapy, past surgery for renal stone, presence of residual fragments were predictors of infective complications. Multivariate analysis did not identify any patient subgroups at a significantly higher risk of infection. The low rate of complications may have limited the conclusions from our study.
  
  
  CONCLUSIONS
  Using a standardized method for the definition and classification of infective complication from a multicentre prospective large database, we find a prevalence of 7.7 % of infective complication among patients undergoing RIRS for renal stone. However, to predict which patients will develop infective complications still remains a clinical challenge.
authors.affiliation: Department of Urology, "S. Pio da Pietrelcina" Hospital, Via San Camillo de Lellis, 1, 66054, Vasto, CH, Italy. berardinelli.francesco@gmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Berardinelli
authors.affiliation: Department of Urology, "S. Pio da Pietrelcina" Hospital, Via San Camillo de Lellis, 1, 66054, Vasto, CH, Italy.
authors.forename: Piergustavo
authors.initials: P
authors.lastname: De Francesco
authors.affiliation: Department of Urology, "S. Pio da Pietrelcina" Hospital, Via San Camillo de Lellis, 1, 66054, Vasto, CH, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Marchioni
authors.affiliation: Faculty of Psychology and Educational sciences, University of Porto, Porto, Portugal.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Cera
authors.affiliation: Ville Turro Division, Urology Department, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Proietti
authors.affiliation: Department of Urology, Austin Health, Melbourne, Australia.
authors.forename: Derek
authors.initials: D
authors.lastname: Hennessey
authors.affiliation: Urologische Klinik, Medizinische Universität Graz, Graz, Austria.
authors.forename: Orietta
authors.initials: O
authors.lastname: Dalpiaz
authors.affiliation: Urologia, Ospedale Cottolengo, Turin, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Cracco
authors.affiliation: Urologia, Ospedale Cottolengo, Turin, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Scoffone
authors.affiliation: Department of Urology, "S. Pio da Pietrelcina" Hospital, Via San Camillo de Lellis, 1, 66054, Vasto, CH, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Schips
authors.affiliation: Ville Turro Division, Urology Department, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Giusti
authors.affiliation: Department of Urology, "S. Pio da Pietrelcina" Hospital, Via San Camillo de Lellis, 1, 66054, Vasto, CH, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Cindolo
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000145:classification* / Q000209:etiology* / Q000382:microbiology; D011446:Prospective Studies; D011704:Pyelonephritis / Q000209:etiology / Q000628:therapy; D012307:Risk Factors; D018805:Sepsis / Q000145:classification* / Q000209:etiology* / Q000382:microbiology; D012720:Severity of Illness Index; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods
keywords: Flexible ureteroscopy; Infective complications; RIRS; Sepsis; Standardized method