Application of Suctioning Ureteral Access Sheath during Flexible Ureteroscopy for Renal Stones Decreases the Risk of Postoperative Systemic Inflammatory Response Syndrome

医学 逻辑回归 全身炎症反应综合征 倾向得分匹配 入射(几何) 泌尿科 输尿管镜检查 内科学 外科 胃肠病学 输尿管 败血症 物理 光学
作者
Xiaoyuan Qian,Chen‐Qian Liu,Senyuan Hong,Jin‐Zhou Xu,Can Qian,Jianning Zhu,Shaogang Wang,Jiaqiao Zhang
出处
期刊:International Journal of Clinical Practice [Wiley]
卷期号:2022: 1-7 被引量:20
标识
DOI:10.1155/2022/9354714
摘要

Purpose. To clarify the efficiency and outcomes of suctioning ureteral access sheath (UAS) during flexible ureteroscopic lithotripsy (fURL) for the management of renal stones. Methods. Between January 2017 and January 2019, a total of 444 patients with renal stones undergoing fURL were divided into suctioning UAS and nonsuctioning UAS groups. The outcomes of patients in both groups were compared using a matched-pair analysis (1 : 1 scenario). Furthermore, a directed acyclic graph (DAG) was drawn to guide the multivariate logistic regression model and analyze the protective effect of suctioning UAS on the incidence of postoperative systemic inflammatory response syndrome (SIRS). Results. Before propensity score matching, significant differences were observed between the two groups in blood white cell counts, urine white cell counts, preoperative fever, preoperative indwelling stents, and laterality ( P < 0.05 ). Eighty-one patients in the suctioning UAS group were successfully matched with 81 patients in the nonsuctioning group. The stone-free rate (SFR) on postoperative day 1 after fURL in the suctioning group was higher than that in the nonsuctioning group (86.4% vs. 71.6%; P = 0.034 ), whereas it was comparable between the two groups 1 month after the surgery (88.9% vs. 82.7%; P = 0.368 ). The incidence of postoperative fever or SIRS was lower in the suctioning group (fever: 3.70% vs. 14.8%; P = 0.030 ; SIRS: 1.23% vs. 12.3%; P = 0.012 ). However, the operative duration was similar in both groups (mean (SD)) (72.9 (28.1) min vs. 80.0 (29.5) min; P = 0.121 ). The result of the multivariate logistic regression model guided by DAG revealed that the application of nonsuctioning UAS (odds ratio: 5.28 [1.38–35.07], P = 0.034 ) during fURL was associated with postoperative SIRS. Conclusions. The application of suctioning UAS during fURL was associated with higher SFR on day 1 after surgery and a lower incidence of postoperative fever or SIRS.
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