Résumé
Objective To investigate the risk factors of urinary tract infection after flexible ureteroscopy combined with holmium laser lithotripsy for kidney calculi with human immunodeficiency virus infection.Methods A total 96 patients from June 2016 to June 2018 were analyzed retrospectively.It included 53 males and 43 females,aged 21 to 57(average 41) years old.All patients were diagnosed with kidney stones by KUB,IVU and CT examination.19 cases of bilateral kidney stones and 37cases in left and 40 cases in right.67 cases of single stones and 29 cases of multiple.There were 34 cases of renal pelvis calculi,19 cases of meddle calyx,17 cases of superior calyx and 26 cases of inferior calyx.Maximum diameter of calculus was 0.8-2.9 cm,average (1.6 ± 0.8) cm,of which 49 cases size were over 2 cm.There is no obvious stenosis of the renal pelvis and ureter.There were 29 cases of CD4 + lymphocyte count ≤400/μl,and 26 cases of preoperative ureteral stents.Urine test and urine bacterial culture were confirmed no urinary tract infection before lithotripsy.46 cases with abnormal white blood cells due to urinary test could not meet the diagnostic criteria for urinary tract infection,and prophylactic antibiotics,51 cases without antibiotics.All 96 cases underwent lithotripsy and record postoperative conditions.Then single factor analysis and multi-factor logistic regression analysis were used to analyze the related factors of urinary tract infection after lithotripsy.Results All 96 cases were successfully completed,no open surgery,no complications.The operation time was 40-130 min (average 57 min),of which 34 cases were over 60 min.Postoperative retained catheter time was 2 to 11 days (average 3.5 days),of which 27 cases were over 7 days.Urinary tract infection occurred in 18 of all patients,with an incidence of 18.8％.The results of urinary bacterial culture in 18 cases were 13 cases of Escherichia coli infection,3 cases of Proteobacteria infection,and 2 cases of fecal cocci infection.There were 14 cases of calculi size over 2 cm,10 cases of CD4+ lymphocyte count ≤ 400/μ l,11 cases of preoperative ureteral stents,3 cases of prophylactic antibiotics,11 cases of operation time over 60 min,and 10 cases of postoperative retained catheter over 7 days.Single factor analysis found that CD4 + lymphocyte count ≤400/μl,preoperative ureteral stents,larger calculi size,longer operation time,postoperative retained catheter for a long time could increase the risk of urinary tract infection after operation (P ＜ 0.05),Preoperative prophylactic antibiotics could reduce the incidence of postoperative infection (P ＜ 0.05).Multivariate logistic regression analysis suggested that CD4 + lymphocyte count ≤400/μl,preoperative ureteral stents,calculi size over 2 cm,operation time more than 60 min,postoperative retained catheter more than 7 days,and no prophylactic antibiotics before surgery were risk factors for postoperative urinary tract infection(P ＜ 0.05).Conclusions CD4 + lymphocyte count ≤ 400/μl,preoperative ureteral stents,calculi size over 2 cm,operation time more than 60 min,postoperative retained catheter more than 7 d,and no preventive use of antibiotics before surgery are risk factors for urinary tract infection after flexible ureteroscopy combined with holmium laser lithotripsy with human immunodeficiency virus infection.
Résumé
Objective@#To investigate the risk factors of urinary tract infection after flexible ureteroscopy combined with holmium laser lithotripsy for kidney calculi with human immunodeficiency virus infection.@*Methods@#A total 96 patients from June 2016 to June 2018 were analyzed retrospectively. It included 53 males and 43 females, aged 21 to 57(average 41) years old. All patients were diagnosed with kidney stones by KUB, IVU and CT examination. 19 cases of bilateral kidney stones and 37cases in left and 40 cases in right. 67 cases of single stones and 29 cases of multiple. There were 34 cases of renal pelvis calculi, 19 cases of meddle calyx, 17 cases of superior calyx and 26 cases of inferior calyx. Maximum diameter of calculus was 0.8-2.9 cm, average(1.6±0.8)cm, of which 49 cases size were over 2 cm. There is no obvious stenosis of the renal pelvis and ureter. There were 29 cases of CD4+ lymphocyte count ≤400/μl, and 26 cases of preoperative ureteral stents. Urine test and urine bacterial culture were confirmed no urinary tract infection before lithotripsy. 46 cases with abnormal white blood cells due to urinary test could not meet the diagnostic criteria for urinary tract infection, and prophylactic antibiotics, 51 cases without antibiotics. All 96 cases underwent lithotripsy and record postoperative conditions. Then single factor analysis and multi-factor logistic regression analysis were used to analyze the related factors of urinary tract infection after lithotripsy.@*Results@#All 96 cases were successfully completed, no open surgery, no complications. The operation time was 40-130 min (average 57 min), of which 34 cases were over 60 min. Postoperative retained catheter time was 2 to 11 days (average 3.5 days), of which 27 cases were over 7 days. Urinary tract infection occurred in 18 of all patients, with an incidence of 18.8%. The results of urinary bacterial culture in 18 cases were 13 cases of Escherichia coli infection, 3 cases of Proteobacteria infection, and 2 cases of fecal cocci infection. There were 14 cases of calculi size over 2 cm, 10 cases of CD4+ lymphocyte count≤400/μl, 11 cases of preoperative ureteral stents, 3 cases of prophylactic antibiotics, 11 cases of operation time over 60 min, and 10 cases of postoperative retained catheter over 7 days. Single factor analysis found that CD4+ lymphocyte count≤400/μl, preoperative ureteral stents, larger calculi size, longer operation time, postoperative retained catheter for a long time could increase the risk of urinary tract infection after operation (P<0.05), Preoperative prophylactic antibiotics could reduce the incidence of postoperative infection (P<0.05). Multivariate logistic regression analysis suggested that CD4+ lymphocyte count ≤400/μl, preoperative ureteral stents, calculi size over 2 cm, operation time more than 60 min, postoperative retained catheter more than 7 days, and no prophylactic antibiotics before surgery were risk factors for postoperative urinary tract infection(P<0.05).@*Conclusions@#CD4+ lymphocyte count ≤400/μl, preoperative ureteral stents, calculi size over 2 cm, operation time more than 60 min, postoperative retained catheter more than 7 d, and no preventive use of antibiotics before surgery are risk factors for urinary tract infection after flexible ureteroscopy combined with holmium laser lithotripsy with human immunodeficiency virus infection.
Résumé
Objective To discuss the efficacy of the flexible ureteroscopy combined with Holmium laser lithotripsy for kidney calculi with HIV positive patients.Methods From May 2015 to May 2016,47 cases of patients with renal calculi were treated by the flexible ureteroscopy combined with Holmium laser lithotripsy in our hospital.There were 29 cases male,18 cases female,aged from 22 to 56 years old,average 39 years.There were 38 cases with single stone,9 cases with multiple stones.There were 9 cases with stones on both sides.Flexible ureteroscopy channel sheath was used in surgery.Stones were fragmented by Holmium laser.During one-month follow-up after surgery,stone removal and stone free rate were recorded.Residual stones were re-treated with a secondary lithotripsy or ESWL.Results The flexible ureteroscopy channel sheath was indwelled successfully in all the cases.All stones were detected.The average operation time was 63min (range,42-141min) and the median postoperative stay was 4.5days (range,2-16 d).Among the 47 patients,41 patients underwent first-stage lithotripsy,6 patients underwent second-stage ESWL after lithotripsy,and 1 patient underwent third-stage lithotripsy.The one-month stone free rate was 87.2％ (41/47).The total stone free rate was 97.9％ (46/47) after second-stage lithotripsy.Postoperative fever occurred in 4 cases after lithotripsy.No blood transfusion,systemic infection,ureteral perforation,or ureteral avulsion occurred.The total complication rate was 8.5％ (4/47).The mean number of CD4 +T lymphocytes before lithotripsy was 402/μl,and was 410/μl 3 days after lithotripsy.There was no Statistical differences between them.Conclusions Flexible ureteroscopy combined Holmium laserlithotripsy could be a safe and effective treatment for kidney calculi patients with HIV/AIDS positive.