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Ureteroscopy for urolithiasis in bedridden patients: it is feasible and acceptable

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Abstract

Purpose

To investigate the safety of transurethral ureteroscopy (URS) for urolithiasis in bedridden patients and to identify bedridden patient-specific risk factors for postoperative complications.

Methods

The patients who underwent URS for urolithiasis were divided into bedridden patients and good performance status (PS) patients, and the groups were compared regarding their clinical characteristics and postoperative complications. A multivariable logistic regression analysis was performed to evaluate independent predictors of postoperative febrile urinary tract infection (fUTI).

Results

A total of 1626 patients were included, 276 in the bedridden patient group, and 1350 in the good PS patient group. The bedridden patient group had a significantly higher age and higher proportion of females and had multiple comorbidities. In 77 patients (27.9%), 88 postoperative complications developed for the bedridden patient group. Clavien–Dindo grade III or IV complications were observed in only 8 patients. No grade V complications were observed. The most common complication was fUTI. The frequency of fUTI with grade III or IV for the bedridden patient group (2.2%) was higher compared with the good PS patient group (0.5%), but the difference was not statistically significant (p = 0.13). Bedridden patient-specific risk factors for fUTI included female sex, diabetes mellitus, cerebrovascular comorbidities, lower extremity contracture, and prolonged operative time.

Conclusion

URS for urolithiasis is a feasible and acceptable procedure in bedridden patients, despite the moderate rate of postoperative complications. The identified risk factors provide a framework for risk stratification and individualized care in this unique patient population.

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Data availability

Data will be provided by the corresponding author upon a reasonable request.

References

  1. Chatterji S, Byles J, Cutler D et al (2015) Health, functioning, and disability in older adults–present status and future implications. Lancet 385:563–575

    Article  PubMed  Google Scholar 

  2. Feigin VL, Forouzanfar MH, Krishnamurthi R et al (2014) Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet 383:245–254

    Article  PubMed  PubMed Central  Google Scholar 

  3. Monga M, Macias B, Groppo E et al (2006) Renal stone risk in a simulated microgravity environment: impact of treadmill exercise with lower body negative pressure. J Urol 176:127–131

    Article  PubMed  Google Scholar 

  4. Yoshimura K, Utsunomiya N, Ichioka K et al (2005) Emergency drainage for urosepsis associated with upper urinary tract calculi. J Urol 173:458–462

    Article  PubMed  Google Scholar 

  5. Baş O, Tuygun C, Dede O et al (2017) Factors affecting complication rates of retrograde flexible ureterorenoscopy: analysis of 1571 procedures—a single-center experience. World J Urol 35:819–826

    Article  PubMed  Google Scholar 

  6. Resorlu B, Unsal A, Ziypak T et al (2013) Comparison of retrograde intrarenal surgery, shockwave lithotripsy, and percutaneous nephrolithotomy for treatment of medium-sized radiolucent renal stones. World J Urol 31:1581–1586

    Article  PubMed  Google Scholar 

  7. Somani BK, Giusti G, Sun Y et al (2017) Complications associated with ureterorenoscopy (URS) related to treatment of urolithiasis: the Clinical Research Office of Endourological Society URS Global study. World J Urol 35:675–681

    Article  CAS  PubMed  Google Scholar 

  8. Xu Y, Min Z, Wan SP et al (2018) Complications of retrograde intrarenal surgery classified by the modified Clavien grading system. Urolithiasis 46:197–202

    Article  PubMed  Google Scholar 

  9. Waseda Y, Takazawa R, Kobayashi M et al (2020) Successful outcomes of endoscopic lithotripsy in completely bedridden patients with symptomatic urinary calculi. Sci Rep 10:8839

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Traxer O, Thomas A (2013) Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol 189:580–584

    Article  PubMed  Google Scholar 

  11. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  12. Singer M, Deutschman CS, Seymour CW et al (2016) The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 315:801–810

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 48:452–458

    Article  CAS  PubMed  Google Scholar 

  14. Clifton MM, Gettman MT, Patterson DE et al (2014) The change in upper tract urolithiasis composition, surgical treatments and outcomes of para and quadriplegic patients over time. Urolithiasis 42:415–419

    Article  CAS  PubMed  Google Scholar 

  15. Koterazawa S, Kanno T, Takahashi T et al (2023) Safety and efficacy of ureteroscopy for urolithiasis in octogenarians. Int J Urol 30:161–167

    Article  PubMed  Google Scholar 

  16. Bagshaw SM, Stelfox HT, McDermid RC et al (2014) Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study. CMAJ 186:E95-102

    Article  PubMed  PubMed Central  Google Scholar 

  17. James LA, Levin MA, Lin HM et al (2019) Association of preoperative frailty with intraoperative hemodynamic instability and postoperative mortality. Anesth Analg 128:1279–1285

    Article  CAS  PubMed  Google Scholar 

  18. Moses RA, Ghali FM, Pais VM Jr et al (2016) Unplanned hospital return for infection following ureteroscopy—can we identify modifiable risk factors? J Urol 195:931–936

    Article  PubMed  Google Scholar 

  19. Özsoy M, Acar Ö, Sarica K et al (2015) Impact of gender on success and complication rates after ureteroscopy. World J Urol 33:1297–1302

    Article  PubMed  Google Scholar 

  20. Uchida Y, Takazawa R, Kitayama S et al (2018) Predictive risk factors for systemic inflammatory response syndrome following ureteroscopic laser lithotripsy. Urolithiasis 46:375–381

    Article  PubMed  Google Scholar 

  21. Breda A, Ogunyemi O, Leppert JT et al (2009) Flexible ureteroscopy and laser lithotripsy for multiple unilateral intrarenal stones. Eur Urol 55:1190–1196

    Article  PubMed  Google Scholar 

  22. Castellani D, Traxer O, Ragoori D et al (2023) Improving outcomes of same-sitting bilateral flexible ureteroscopy for renal stones in real-world practice-lessons learnt from global multicenter experience of 1250 patients. Eur Urol Open Sci 52:51–59

    Article  PubMed  PubMed Central  Google Scholar 

  23. Yamashita S, Kohjimoto Y, Hirabayashi Y et al (2017) Upper urinary tract stone disease in patients with poor performance status: active stone removal or conservative management? BMC Urol 17:103

    Article  PubMed  PubMed Central  Google Scholar 

  24. Cicione A, Stira J, Tema G et al (2023) Ureteral stent encrustation: evaluation of available scores as predictors of a complex surgery. Minerva Urol Nephrol 75:359–365

    Article  PubMed  Google Scholar 

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Urology, Ijinkai Takeda General Hospital, 28-1 Moriminami-Cho, Ishida Fushimi-Ku, Kyoto, 601-1495, Japan

    Shigeki Koterazawa, Toshifumi Takahashi, Shinya Somiya, Katsuhiro Ito, Takao Haitani, Toru Kanno, Yoshihito Higashi, Hitoshi Yamada & Masaaki Imamura

Authors
  1. Shigeki Koterazawa
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  2. Toshifumi Takahashi
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  3. Shinya Somiya
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  4. Katsuhiro Ito
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  5. Takao Haitani
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  6. Toru Kanno
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  7. Yoshihito Higashi
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  8. Hitoshi Yamada
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  9. Masaaki Imamura
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Contributions

Shigeki Koterazawa: data collection or management, data analysis, manuscript writing/editing; Toshifumi Takahashi: data collection or management; Shinya Somiya: data collection; Katsuhiro Ito: data collection or management; Takao Haitani: data collection; Toru Kanno: data collection or management; Yoshihito Higashi: data collection; Hitoshi Yamada: data collection or management; Masaaki Imamura: manuscript writing/editing, protocol/project development.

Corresponding author

Correspondence to Masaaki Imamura.

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Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. The institutional review board approved this study (#R2020005).

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Supplementary Information

Below is the link to the electronic supplementary material.

345_2024_4895_MOESM1_ESM.tiff

Supplementary Fig. 1 A case of surgical posture in patients who could not open their legs for the lithotomy position. (TIFF 16985 KB)

345_2024_4895_MOESM2_ESM.tiff

Supplementary Fig. 2 Incidence of postoperative febrile urinary tract infection according to the number of risk factors present (female sex, diabetes mellitus, cerebrovascular comorbidities, lower extremity contracture, and prolonged operative time [≥ 90 min]). (TIFF 42182 KB)

Supplementary Table 1. Detailed data on bedridden patients. (XLSX 10 KB)

345_2024_4895_MOESM4_ESM.xlsx

Supplementary Table 2. Multivariate analysis of predictors of postoperative complications and febrile urinary tract infection after propensity adjustment. (XLSX 10 KB)

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Koterazawa, S., Takahashi, T., Somiya, S. et al. Ureteroscopy for urolithiasis in bedridden patients: it is feasible and acceptable. World J Urol 42, 272 (2024). https://doi.org/10.1007/s00345-024-04895-5

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