Analysis Of Risk Factors Of Double J Stent Related Infection After Laparoscopic Pyeloplasty

Background:Ureteropelvic junction obstruction is the most common obstructive urinary disease in infants and the most common cause of hydronephrosis in children,with an incidence of 1/1500～1/750.For these children,close follow-up should be carried out after birth.During the follow-up,the children with gradually aggravated hydronephrosis or related symptoms should be treated with surgical intervention.Compared with the classical open pyeloplasty,laparoscopic pyeloplasty has the advantages of less trauma,quick recovery,short hospital stay and less complications,so it is a popular method for the treatment of UPJO.According to the literature,the success rate of LP operation was more than 95%.After this operation,routine indwelling double J stent drainage is needed,but during the period of indwelling double J tube,the incidence of urinary tract infection reported in the literature was 7.8%～10.0%.It is a common complication during indwelling double J stent after laparoscopic pyeloplasty.Urogenic sepsis can occur in severe cases,and urinary system infection is one of the important factors affecting the success of LP operation.Repeated urinary tract infection will affect the healing of surgical anastomosis and lead to the formation of scar stricture,which might lead to surgical failure.Therefore,to study the risk factors of double J stent-related urinary tract infection and taking timely and effective intervention measures according to the independent risk factors can provide an effective strategy for preventing the failure of laparoscopic pyeloplasty.Objective:To analyze the incidence of urinary system infection during indwelling double J tube after laparoscopic pyeloplasty in children with ureteropelvic junction obstruction and to find out the related risk factors.Methods:A total of 121 patients with unilateral ureteropelvic junction obstruction who received laparoscopic pyeloplasty with double J stent in the Department of Pediatric Urology,affiliated Provincial Hospital of Shandong University from November 2015 to September 2020 were analyzed retrospectively.according to the occurrence of symptomatic urinary tract infection during the indwelling double J stent,the children were divided into infection group(n=14)and non-infection group(n=107).The relationship between the occurrence of urinary tract infection and age,body weight,gender,surgical side,with or without clinical symptoms before operation,anterior and posterior diameter of renal pelvis before operation,thickness of renal cortex before operation,differential renal function and the size of double J stent were analyzed.Results:During the period of indwelling double J stent,symptomatic urinary tract infection occurred in 14 cases(11.57%).Urine bacterial culture was performed in 7 cases of Escherichia coli(50%),2 cases of Klebsiella pneumoniae(14.29%)and 5 cases of Enterococcus faecalis(35.71%).Statistical analysis of the data between the infection group and the non-infection group showed that there was no significant difference in gender,surgical side,anterior and posterior diameter of renal pelvis,renal function and the size of double J stent between the two groups(P>0.05),but there were significant differences in age(P=0.02),body weight(P=0.02),clinical symptoms(P=0.04)and renal cortex thickness(P=0.003).Furthermore,age,body weight,preoperative renal cortical thickness and preoperative clinical symptoms were analyzed by multi-element logistic regression analysis.It was found that body weight(OR=0.847,95%CI:0.721～0.994)and preoperative renal cortical thickness(OR=0.007,95%CI:0-0.491)were independent risk factors for postoperative urinary tract infection.Furthermore,the ROC curve was drawn for body weight and preoperative renal cortical thickness.The area under the ROC curve of body weight and preoperative renal cortical thickness predicting postoperative urinary tract infection were 0.70(95%CI:0.58～0.81,P<0.05)and 0.74(95%CI:0.60～0.88,P<0.01).The best cut-off values of body weight and preoperative renal cortex thickness were 13.75kg and 0.25cm,respectively.Conclusion:The urinary tract infection during indwelling double J stent was a common complication after laparoscopic pyeloplasty for the treatment of ureteropelvic junction obstruction.Statistical analysis showed that body weight<13.75kg and preoperative renal cortex thickness<0.25cm were independent risk factors for postoperative symptomatic urinary tract infection.For these children,prophylactic application of antibiotics after operation might help to reduce the incidence of urinary tract infection and improve the success of LP surgery.