Severe infection after ureteroscopic holmium laser lithotripsy / 中华泌尿外科杂志

ABSTRACT

Objective To investigate the etiology and treatment of severe infection after ureteroscopic holmium laser lithotripsy. Methods Seven cases (2 men and 5 women) of severe infection after holmium laser lithotripsy under ureteroscope were treated.Their mean age was 44 years (range,37-56 years). The patients were characterized by a temperature over 39 ℃,a heart rate over 110 BPM,and a blood pressure below 80/50 mm Hg (1 mm Hg=0.133 kPa) within 1-12 hours after the operation.The diagnosis of septic shock caused by gram negative bacteria was suggested by the clinical manifestation and the urine culture. Anti-shock therapy was conducted with rapid supplement of colloidal and crystalloid solution of 3000-4000 ml.The vasoactive drugs,dopamine (2-5 ?g/kg per minute) or norepinephrine (4-8 ?g/kg per minute) were used for the establishment of stable circulation,and the third generation cephalosporins for the control of infection empirically.Low dose corticosteroids (dexamethasone,10-20 mg) were administered if the patients had adrenocortical insufficiency or significant intoxication. Results All patients were treated successfully within 8 to 48 hours,then the hypertensors were gradually stopped.Their temperature and blood routine tests returned to normal 3 days later.. Conclusions The causes of severe infection after holmium laser lithotripsy under ureteroscope are preoperative urinary tract infection,high perfusion pressure or postoperative urinary tract obstruction.Peri operative anti infection and appropriate operation skill can effectively prevent the infection.