Prognostic factors for the safety and efficacy of retrograde laser lithotripsy: Data from a contemporary series of 155 consecutive patients with single and multiple lithiasis of the urinary tract.

Treatment of large and multiple stones located in the ureter and/or the kidney may be challenging. The aim of the current study was to evaluate the results and complications of retrograde endoscopic lithotripsy for stones located in the urinary tract and to determine prognostic factors for treatment outcome. From April 2017 to March 2020, eligible patients for the active treatment of ureterolithiasis with or without concomitant nephrolithiasis <20 mm were enrolled in the study. The prognostic factors for the stone free rate (SFR) after the 1st and subsequent sessions and overall complications were assessed. Patients were divided into single or multiple lithiasis groups (groups A and B respectively). A comparison between these two groups was then conducted. Overall, 237 stones were detected in 155 patients, representing a mean burden of 1.53 stone per patient. The mean total stone size was 14.7 mm, the initial SFR was 80% and the final SFR (after a mean of 1.23 session per patient) was 94.2%. The rate of complications was 26.4%. Multivariative analysis revealed that preoperative stenting and total stone size were independent prognostic factors of initial SFR, while no independent factors were determined for final SFR. Age, total size and stones in the lower calyx were independent factors for complications. In group A and B, 114 and 41 cases with solitary and multiple stones were included, respectively. Excluding operation time (P=0.002), no significant differences were recorded in terms of initial (P=0.255) and final SFR (P=0.056), hospital stay (P=0.308), mean number of treatments (P=0.757) and the rate of complications (P=0.218) between the two groups. In conclusion, retrograde endoscopic management of multiple lithiasis has a favorable outcome irrespective of stone location. Older patients with higher burdens and stones in the lower calyx should be treated with caution.

Feasibility of a single session retrograde endoscopic laser lithotripsy of two large stones located in a bifid urinary tract. Presentation of a rare case.

A 76 year-old male presented with urosepsis and acute renal injury secondary to obstruction by a 13 mm stone located in the common segment of a bifid left ureter. A second 10 mm stone was detected in the mid calyx of the lower moiety of the kidney. Drainage of both moieties with two double-J stents was initially performed. Following recovery from urosepsis a retrograde endoscopic semirigid and flexible laser lithotripsy of the distal and proximal stone respectively was performed resulting in stone clearance. Although retrograde ureterolithotripsy has been presented in the past, to the best of the authors' knowledge, this is the first description of flexible retrograde intrarenal lithotripsy performed through a bifid ureter.

Clinical Outcome and Prognostic Factors of Sepsis, Septic Shock and Prolonged Hospitalization, of Patients Presented with Acute Obstructive Pyelonephritis.

Objective: To investigate prognostic factors of outcome of acute obstructive pyelonephritis (AOP). Materials and Methods: Patients with AOP were prospectively evaluated and logistic regression analysis was applied to identify factors associated with the duration of hospital stay and occurrence of sepsis and septic shock. Results: Based on CT scan findings, 62 patients were found to have AOP and subjected to emergency drainage. The main etiology of obstruction was lithiasis (70.9%). Double-J stent and percutaneous nephrostomy were introduced in 48 and 14 patients, respectively. Urosepsis and septic shock were diagnosed in 20 (32%) and 6 (9.7%) patients, respectively. None of the patients died of sepsis. In univariative analysis, older age, high neutrophils, increased serum creatinine, higher Charlson comorbidity index (CCI) score, any CCI score ≥1, diabetes mellitus (DM) longer operation time (OT), and multiresistant stains were risk factors of sepsis. Gender, type of drainage, laterality, white blood cell count, neutrophils rate >80%, C-reactive protein, and the presence of malignancy or lithiasis were not. Age, DM, and CCI score ≥1 were associated with prolonged hospitalization. None of the factors was associated with shock. In multivariative models, age (odds ratio [OR]: 1.09, 95% confidence interval [CI]: 1.02-1.16, p = 0.010), multiresistant strains (OR: 16.36, 95% CI: 1.97-135.71, p = 0.006), OT >20 minutes (OR: 1.03, 95% CI: 1.00-1.07, p = 0.048), and elevated creatinine (OR: 1.68, 95% CI: 1.001-2.84, p = 0.049) were independent prognostic factors of sepsis, and DM (OR: 30.8%, CI: 8.86%-52.8%, p = 0.007) was a prognostic factor of longer hospitalization. Conclusions: One-third of AOP patients will develop sepsis. Older age, elevated serum creatinine, longer OT presence of multiresistant strains, and DM are independent factors of worse outcome.