Can we predict the incidence of high-grade Clavien-Dindo complications in patients with forgotten encrusted stents undergoing endourologic management?
Objective: Ureteral stents are customarily inserted to facilitate urinary drainage, but they come with their own glitches of being forgotten and/or encrusted leading to serious consequences. The present study aimed to report the complications in patients with forgotten and encrusted stents according...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-01-01
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| Series: | Asian Journal of Urology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214388223000036 |
| _version_ | 1797345958120390656 |
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| author | Praanjal Gupta Ramanitharan Manikandan Lalgudi Narayanan Dorairajan Kodakattil Sreenivasan Sreerag Sidhartha Kalra Swapnil Singh Kushwaha |
| author_facet | Praanjal Gupta Ramanitharan Manikandan Lalgudi Narayanan Dorairajan Kodakattil Sreenivasan Sreerag Sidhartha Kalra Swapnil Singh Kushwaha |
| author_sort | Praanjal Gupta |
| collection | DOAJ |
| description | Objective: Ureteral stents are customarily inserted to facilitate urinary drainage, but they come with their own glitches of being forgotten and/or encrusted leading to serious consequences. The present study aimed to report the complications in patients with forgotten and encrusted stents according to the Clavien-Dindo system specific to urological procedures and identify the factors leading to high-grade (Clavien-Dindo Grade 4A or above) complications. Methods: The hospital records of patients with forgotten encrusted double-J stents over a period of 8 years were reviewed. The parameters recorded included patient demographics, indwelling time, need for percutaneous nephrostomy, hemodialysis, urine culture, blood culture, total blood counts, serum creatinine, radiologic findings, management techniques, number of surgical interventions, modified Clavien-Dindo complications, follow-up, and mortality, if any. Results: Forty patients were included in the study. The median age was 52 (range 6–85) years. Of the total, 25 (62.5%) patients had a “significant” stent load; 31 (77.5%) had renal failure or acute kidney injury on presentation; 19 (47.5%) patients had sepsis at presentation. Among the patients presented with sepsis, 11 (57.9%) patients demonstrated a positive urine culture; and 7/11 (63.6%) patients exhibited pan-resistant organisms. Twelve out of 40 (30.0%) patients in our series developed high-grade Clavien-Dindo complications. On univariate analysis, sepsis at presentation (p=0.007), stent load (p=0.031), diabetes (p=0.023), positive urine culture (p=0.007), and stent indwelling time of more than 1 year (p=0.031) were found to be significant. On multivariate logistic regression analysis, sepsis at presentation (p=0.017) and positive urine culture (p=0.016) were significant predictors for high-grade complications. Conclusion: It is prudent to identify specific risk factors, namely sepsis at presentation and positive urine culture to triage and optimize these patients before surgical management. |
| first_indexed | 2024-03-08T11:26:17Z |
| format | Article |
| id | doaj.art-eb1469812ac34cda9ad56ab921efcf4f |
| institution | Directory Open Access Journal |
| issn | 2214-3882 |
| language | English |
| last_indexed | 2024-03-08T11:26:17Z |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Asian Journal of Urology |
| spelling | doaj.art-eb1469812ac34cda9ad56ab921efcf4f2024-01-26T05:33:24ZengElsevierAsian Journal of Urology2214-38822024-01-0111199104Can we predict the incidence of high-grade Clavien-Dindo complications in patients with forgotten encrusted stents undergoing endourologic management?Praanjal Gupta0Ramanitharan Manikandan1Lalgudi Narayanan Dorairajan2Kodakattil Sreenivasan Sreerag3Sidhartha Kalra4Swapnil Singh Kushwaha5Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IndiaCorresponding author.; Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IndiaDepartment of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IndiaDepartment of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IndiaDepartment of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IndiaDepartment of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IndiaObjective: Ureteral stents are customarily inserted to facilitate urinary drainage, but they come with their own glitches of being forgotten and/or encrusted leading to serious consequences. The present study aimed to report the complications in patients with forgotten and encrusted stents according to the Clavien-Dindo system specific to urological procedures and identify the factors leading to high-grade (Clavien-Dindo Grade 4A or above) complications. Methods: The hospital records of patients with forgotten encrusted double-J stents over a period of 8 years were reviewed. The parameters recorded included patient demographics, indwelling time, need for percutaneous nephrostomy, hemodialysis, urine culture, blood culture, total blood counts, serum creatinine, radiologic findings, management techniques, number of surgical interventions, modified Clavien-Dindo complications, follow-up, and mortality, if any. Results: Forty patients were included in the study. The median age was 52 (range 6–85) years. Of the total, 25 (62.5%) patients had a “significant” stent load; 31 (77.5%) had renal failure or acute kidney injury on presentation; 19 (47.5%) patients had sepsis at presentation. Among the patients presented with sepsis, 11 (57.9%) patients demonstrated a positive urine culture; and 7/11 (63.6%) patients exhibited pan-resistant organisms. Twelve out of 40 (30.0%) patients in our series developed high-grade Clavien-Dindo complications. On univariate analysis, sepsis at presentation (p=0.007), stent load (p=0.031), diabetes (p=0.023), positive urine culture (p=0.007), and stent indwelling time of more than 1 year (p=0.031) were found to be significant. On multivariate logistic regression analysis, sepsis at presentation (p=0.017) and positive urine culture (p=0.016) were significant predictors for high-grade complications. Conclusion: It is prudent to identify specific risk factors, namely sepsis at presentation and positive urine culture to triage and optimize these patients before surgical management.http://www.sciencedirect.com/science/article/pii/S2214388223000036ForgottenEncrusted stentOutcomePredictorClavien-Dindo complication |
| spellingShingle | Praanjal Gupta Ramanitharan Manikandan Lalgudi Narayanan Dorairajan Kodakattil Sreenivasan Sreerag Sidhartha Kalra Swapnil Singh Kushwaha Can we predict the incidence of high-grade Clavien-Dindo complications in patients with forgotten encrusted stents undergoing endourologic management? Asian Journal of Urology Forgotten Encrusted stent Outcome Predictor Clavien-Dindo complication |
| title | Can we predict the incidence of high-grade Clavien-Dindo complications in patients with forgotten encrusted stents undergoing endourologic management? |
| title_full | Can we predict the incidence of high-grade Clavien-Dindo complications in patients with forgotten encrusted stents undergoing endourologic management? |
| title_fullStr | Can we predict the incidence of high-grade Clavien-Dindo complications in patients with forgotten encrusted stents undergoing endourologic management? |
| title_full_unstemmed | Can we predict the incidence of high-grade Clavien-Dindo complications in patients with forgotten encrusted stents undergoing endourologic management? |
| title_short | Can we predict the incidence of high-grade Clavien-Dindo complications in patients with forgotten encrusted stents undergoing endourologic management? |
| title_sort | can we predict the incidence of high grade clavien dindo complications in patients with forgotten encrusted stents undergoing endourologic management |
| topic | Forgotten Encrusted stent Outcome Predictor Clavien-Dindo complication |
| url | http://www.sciencedirect.com/science/article/pii/S2214388223000036 |
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