Risk factors of SIRS following retrograde intrarenal surgery in the treatment of urolithiasis

Abstract:

Objective：To investigate the risk factors of systemic inflammatory response syndrome（SIRS） after retrograde intrarenal surgery（RIRS） with holmium laser lithotripsy in patients with renal or/and proximal ureteral calculi. Methods：The clinical data of 890 patients who underwent RIRS with holmium laser lithotripsy for renal or/and proximal ureteral calculi were retrospectively ana－lyzed from November 2013 to August 2016. The patients were divided into two groups，and the odds ratio（OR） and the 95% confi－dence interval（95%CI） were calculated by univariate and multivariate logistic regression analysis to determine the risk factors after RIRS. Results：In 890 patients（male 584，female 306），SIRS（37/890） was found in all of the 4.2% patients. In univariate analysis，SIRS was significantly related with the use of immuno－suppressive agents，a recent history of stone ralated fever，pre－operative positive urine culture，preoperative WBCs in urine，and urine pus during operation（P<0.05）. SIRS was not correlated with gender，age，BMI，hypertension，diabetes mellitus before opera－tion，the serum creatinine level，operation time，and stone size（P>0.05）. Multivariate analysis further confirmed that SIRS was signifi－cantly associated with a recent history of stone related fever（P=0.014，OR=4.22，95%CI=1.341 to 13.331），preoperativeurine WBCs increase（≥544/mL）（P<0.001，OR=5.075，95%CI=2.350 to 10.959），intraoperative urine pus（P<0.001，OR=8.373，95%CI=2.773 to 25.279）. Conclusion：A recent history of stone related fever，preoperative WBCs in urine，intraoperative urine pus are risk factors for SIRS after RIRS. The risks should be paid for full attention，controlled and treated before operation，if necessary，surgical staging should be needed.