Presented by: Kyeng Hyun Nam MD
Department of Urology, Gangneung Asan Medical Center, University of Ulsan College of Medicine, Gangneung, 25440, Republic of Korea

Introduction

We retrospectively evaluated the safety of high pressure automated irrigation pump (AIP) during retrograde intrarenal surgery (RIRS) by evaluating postoperative infectious complications and the impact of long-term renal function.

Materials

We included 155 RIRS cases conducted in Gangneung Asan Hospital from June 2020 to December 2021 with AIP pressure setting > 250mmHg using disposable flexible ureteroscope (LithoVue^TM). All enrolled patients checked vital signs every four hours and lab data twice (six hours and next day after RIRS) to evaluate postoperative inflammatory complications after RIRS. To evaluate the long-term effect of RIRS on renal function, eGFR and serum creatinine were additionally measured one month after surgery. Patients are categorized into two groups according to postoperative infectious complication; no infectious complication and patients with infectious complication including systemic inflammatory response syndrome (SIRS), sepsis and septic shock.

Results

,

After RIRS, complications of grade II or higher occurred in 11 patients (7.1%) according to the Clavien-Dindo classification. Infectious complications occurred in 13 (8.3%) patients postoperatively, all of which improved with appropriate intravenous antibiotics and fluid resuscitation and were discharged safely. Linear mixed model demonstrated that white blood cell (WBC) increased six hours after RIRS, but improved the next day (p < 0.001). ln (CRP) increased in statistical significance after six hours and the day after RIRS from baseline (p <0.001), but all within the normal range. When analyzing the changes in renal function after one month compared to baseline, ln (Creatinine) decreased from baseline (p = 0.037), and eGFR was significantly improved from baseline (p = 0.006). In subgroup analysis, renal function change between no infectious complication group and infectious complication group showed no significant differences (p =0.29).

Conclusion

RIRS using a single channel flexible ureteroscope can be performed without increasing the risk of infectious complications with the high pressure AIP setting > 250 mmHg. In addition, the occurrence of infectious complications is estimated to have little relevance to long-term renal damage after RIRS.

Funding

I have no conflict of interest to disclose.

No funding.

Co-Authors

Wook Nam, MD
Department of Urology, Gangneung Asan Medical Center, University of Ulsan College of Medicine, Gangneung, 25440, Republic of Korea

Han Gwun Kim, MD, PHD
Department of Urology, Gangneung Asan Medical Center, University of Ulsan College of Medicine, Gangneung, 25440, Republic of Korea

Jong Yeon Park, MD, PHD
Department of Urology, Gangneung Asan Medical Center, University of Ulsan College of Medicine, Gangneung, 25440, Republic of Korea

Sung Jin Kim, MD, PHD
Department of Urology, Gangneung Asan Medical Center, University of Ulsan College of Medicine, Gangneung, 25440, Republic of Korea

Han Kyu Chae, MD, PHD
Department of Urology, Gangneung Asan Medical Center, University of Ulsan College of Medicine, Gangneung, 25440, Republic of Korea