Presented by: Luigi Candela MD
Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy. Università Vita-Salute San Raffaele, Milan, Italy.

Introduction

The use of ureteral access sheath (UAS) improves the irrigation flow during ureteroscopy (URS), thus limiting the increase of intrarenal pressure and temperature. Elevated intrarenal pressure and temperature may cause renal parenchymal impairment. We aimed at evaluating the relationship between the UAS use and the occurrence of post-operative acute kidney injury (AKI) in stone patients treated with URS.

Materials

Data from 584 patients treated with URS and Ho:YAG laser lithotripsy for ureteral/renal stone from February 2015 to October 2022 at a single academic referral centre were analysed. UAS (10/12 Fr) placement was attempted during intrarenal surgery. Post-operative AKI was defined as an increasing of serum creatinine level >0.3mg/dL within post-operative day two according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. 

Univariable (UVA) and multivariable (MVA) logistic regression analyses tested the association of patients’ characteristics (age at surgery, CCI score, renal function, stone diameter, hydronephrosis, stone location, pre-stenting) and operative data (use of UAS, operative time) with the rate of post-operative AKI. 

Results

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Complete data including pre- and post-operative serum creatinine levels of 150 URS procedures were available. Median (IQR) age was 58 (48-68) years, and median (IQR) operative time was 60 (45-90) minutes. Eighty-four (58%) patients were male and 20 (13%) patients had a CCI ≥ 1. Median (IQR) preoperative serum creatinine level and estimated Glomerular Filtration Rate (eGFR) were 1 (0.85-1.25) mg/dL and 74 (54-88) mL/min, respectively. Overall, 44 (29%) patients had preoperative chronic kidney disease stage ≥3 (i.e. eGFR<60 mL/min). Stone was located in kidney, ureter or both in 46 (31%), 74 (49%) and 30 (20%) patients, respectively. UAS was used in 77 (51%) procedures. Overall, post URS AKI occurred in 12 (8%) patients; of those, 6 procedures were carried out with and 6 without UAS. At UVA and MVA performing URS without UAS was not associated with an increased risk of AKI (OR=1.97;95%CI=0.43-8.97;p=0.38). Interestingly, age at surgery and operative time resulted independent predictors of post-operative AKI (OR=1.07;95%CI=1.00-1.13;p=0.03 and OR=1.02;95%CI=1.00-1.03;p=0.02, respectively).

Conclusion

AKI is a not neglectable postoperative complication in patients treated with URS.  The use of UAS does not influence the onset of post URS AKI. However, older age and longer URS procedure are associated with a higher risk of developing post-operative AKI. Current findings should be considered for the peri-operative management of stone patients treated with URS.

Funding

none

Co-Authors

Luca Villa, MD
Università Vita- Salute San Raffaele, Milan, Italy

Margherita Fantin, MD
Università Vita-Salute San Raffaele, Milan, Italy

Catalina Solano, MD
Urology Unit, Tenon Hospital, Paris, France

Mariela Corrales, MD
Urology Unit, Tenon Hospital, Paris, France

Marie Chicaud, MD
Urology Unit, Tenon Hospital, Paris, France

Stessy Kutchukian, MD
Urology Unit, Tenon Hospital, Paris, France

Frederic Panthier, MD
Urology Unit, Tenon Hospital, Paris, France

Steeve Doizi, MD
Urology Unit, Tenon Hospital, Paris, France

Alessia D'Arma,
Università Vita-Salute San Raffaele, Milan, Italy

Olivier Traxer, MD
Urology Unit, Tenon Hospital, Paris, France

Eugenio Ventimiglia, MD
Università Vita-Salute San Raffaele, Milan, Italy

Francesco Montorsi, MD
Università Vita-Salute San Raffaele, Milan, Italy

Andrea Salonia, MD
Università Vita-Salute San Raffaele, Milan, Italy