Abstract: PD16-04
Sources of Funding: none

Introduction

Retrograde endoscopic surgery has become a powerful tool in the treatment of ureteral and renal calculi. Infectious complications from these procedures however are a major concern, with rates ranging from 7 -25%. Mortality from septic complications has been reported as high as 25%. The purpose of this study is to share our easily implementable infection reduction bundle.

Methods

All retrograde endoscopic cases for ureteral and kidney stones undertaken from 2012- 2014 were reviewed retrospectively. All patients were subject to the same protocol as follows. _x000D_ _x000D_ 1) Once a safety wire was in place, IV furosemide (20mg) was administered to induce a brisk diuresis and to provide an increased pressure gradient against pyelovenous backflow._x000D_ 2) Low-pressure environment is maintained by gravity irrigation only (40-60cmH2O). Pressure irrigation is never utilized. _x000D_ 3) 2-way intermittent suction device is used to allow improved visibility and periodic reduction in renal pelvic pressure._x000D_ 4) Complex cases which require longer operative time (>2 hours) are staged._x000D_ _x000D_ Patients&[prime] charts were queried for post-operative infectious complications._x000D_ _x000D_

Results

194 patients were included in the study with 266 treatment episodes. 205 stone burdens underwent single session treatments while 29 stone burdens required two sessions and one stone burden required a third. 23% of patients had a history of UTIs and 32% of patients grew bacteria from their stones. No patients returned to the emergency department or required readmission to the hospital due to an infectious complication. No cases of fever or sepsis were noted.(Table 1)

Conclusions

We present a protocol for reduction of infection risk that has yielded excellent outcomes in a tertiary care population without sacrificing stone-free rates. Each step of our protocol is done to minimize the amount of bacteria and endotoxins that can reach the systemic circulation. This is done by increasing the pressure gradient against pyelovenous backflow via the use of furosemide, and minimizing renal pelvic pressure through low pressure gravity irrigation using an intermittent 2-way suction pump. Staging procedures further reduces risk by minimizing time infectious material can be absorbed. Lastly, our protocol is easily implementable into any stone practice.

Funding

none