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Risk Factors for Urinary Septic Shock Following Ureteroscopy for Stone Disease - Beyond the Abstract

Ureteroscopy (URS) is a cornerstone in the management of urolithiasis, offering a minimally invasive solution with high success rates. However, post-URS infectious complications remain a significant concern, with septic shock being the most severe and life-threatening. While previous studies have explored risk factors for urosepsis, our study specifically aimed to identify the risk factors for septic shock, a complication with high morbidity and mortality.

Key Findings and Clinical Implications
In our retrospective analysis of 5,000 ureteroscopy procedures, 20 cases of urinary septic shock were identified. Multivariate analysis revealed that the strongest independent risk factors for developing septic shock after ureteroscopy were:

  • Age >55 years (OR = 1.3, p = 0.003)
  • Body mass index (BMI) >26 (OR = 1.7, p = 0.011)
  • Positive preoperative urine culture (OR = 48.7, p = 0.017)
While diabetes, ischemic heart disease, and stone size/multiplicity were more common among septic shock patients, these factors lost significance in multivariate analysis, suggesting that other variables play a stronger role in predicting septic shock.

Positive preoperative urine cultures were significantly more prevalent in patients who progressed to septic shock and remained an independent risk factor, underscoring the importance of infection control before surgery. While prolonged preoperative drainage was also more common in these patients, its independent role in predicting septic shock requires further investigation.

From a clinical perspective, patients over 55, those with a BMI above 26, and those with positive preoperative urine cultures should receive enhanced infection control measures, including targeted antibiotic therapy and closer perioperative monitoring.

Future Directions
While our study provides key insights into septic shock risk factors, further prospective studies are needed to develop predictive models for patient risk stratification. Additionally, investigating the role of intraoperative variables, including surgical technique, irrigation pressure, and the impact of prophylactic antibiotics, could further refine infection prevention strategies.

Conclusion
Although uncommon, urinary septic shock following ureteroscopy remains a serious clinical concern due to its high morbidity and mortality. Our findings suggest that older age, obesity, and positive preoperative urine cultures are the most significant risk factors. By identifying high-risk patients and implementing early preventive measures, we can potentially reduce the incidence of severe infectious complications and improve patient safety in endourology.

Written by: Ameer Nsair,1,2 Michael Mullerad,1 Oleg Goldin,1 Gilad E Amiel,1,2 Michael Reumi,2,3 Kamil Malshy,4 Azik Hoffman,1,2

  1. Department of Urology, Rambam Health Care Campus, Haifa, Israel.
  2. Intensive Care Unit, Rambam Health Care Campus, Haifa, Israel.
  3. Technion-Israel Institute of Technology, Haifa, Israel.
  4. Department of Urology, University of Rochester Medical Center, Rochester, NY, USA.
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