RISK FACTORS FOR INFECTIOUS COMPLICATIONS IN PATIENTS WHO UNDERWENT RETROGRADE INTRA RENAL SURGERY (RIRS).

Abstract

Background: Retrograde intrarenal surgery (RIRS) has become an increasingly popular minimally invasive technique for the management of renal calculi. Despite its safety profile, infectious complications such as urinary tract infection (UTI), fever, and urosepsis remain clinically significant and can increase morbidity, hospital stay, and healthcare costs. Identifying risk factors associated with post-RIRS infectious complications is essential for improving patient outcomes. This study aimed to evaluate the risk factors for infectious complications in patients undergoing RIRS at a tertiary care centre in Pakistan.

Methodology: This prospective observational study was conducted at Pakistan Kidney Centre over a period of two years, including 240 patients who underwent RIRS for renal stones. Demographic data, comorbidities, preoperative urine culture, stone burden, operative time, intraoperative irrigation pressure, stent placement, and perioperative antibiotic use were recorded. Patients were monitored for postoperative infectious complications including fever, urinary tract infection, and sepsis. Statistical analysis was performed using SPSS version 25, and multivariate logistic regression was applied to identify independent risk factors. A p-value of <0.05 was considered statistically significant.

Results: Out of 240 patients, infectious complications were observed in a significant proportion of cases. The most common complication was postoperative fever, followed by urinary tract infection and urosepsis. Significant risk factors identified included positive preoperative urine culture, prolonged operative time (>60 minutes), large stone burden (>2 cm), high intrarenal pressure during irrigation, and diabetes mellitus. Patients with preoperative double J stent placement had a lower risk of infection. Multivariate analysis confirmed that positive urine culture and prolonged operative time were independent predictors of post-RIRS infectious complications (p<0.05).

Conclusion: Infectious complications following RIRS are influenced by multiple preoperative and intraoperative factors. Positive urine culture, prolonged operative duration, large stone burden, and diabetes mellitus significantly increase the risk of postoperative infection. Proper preoperative evaluation, sterile urine confirmation, optimized operative time, and careful patient selection can significantly reduce infectious morbidity following RIRS.