Analysis Of 4 Cases With Urosepsis After Retrograde Intrarenal Surgery

Objective:To investigate general information, clinical manifestations, laboratory outcome, treatment, and clinical outcomes of 4 patients with urosepsis after retrograde intrarenal surgery( RIRS) retrospectively and to improve the diagnosis and treatment of urosepsis. Methods:4 cases were diagnosised as urosepsis among who had RIRS at the second hospital of Zhengzhou University from September 2013 to September 2015. They were analysed on general information, clinical manifestations, laboratory outcome, treatment, and clinical outcomes retrospectively. Results:4 cases were all female. The ages ranged from 25 years old to 59 years old,and the average age was 41 years old. 3 cases were kidney stones while 1 cases was upper ureteral calculi,among which there was one bilateral renal calculus. 3 patients came to the hospital for the waist sour, fever, oliguria and other discomfort at the first time, 1 case was diagnosised with renal stone by B-ultrasound when had a physical examination. 3 cases had renal percussive pain. 4 case' preoperative urine routine suggested urinary tract infection with WBC++~++++. Two cases' middle urine culture outcome were all escherichia coli and sensitive to cefotiam.All cases were given the antimicrobial therapy until the urinary tract infection was controlled. 4 cases' operation was successfully completed and the operation time was 70min?90min?55min?100min respectively. To test routine blood test,the urine routine,urine culture, PCT, CRP and renal function?The test above and blood culture should be reexamined when had shiver or fever at the first time.WBC changed firstly in the case 1. Body temperature, respiration, pulse, white blood cell count, hemoglobin changed firstly in the case 2. Body temperature, hemoglobin and blood glucose were the firstly changed factors in the case3. Pulse, respiration, hemoglobin changed firstly in the case 4. Supplementary blood volume and symptomatic supportive treatment were carried out and the laboratory items above were reexamined once the items above were abnormal. Escalation of antimicrobial agents of 4 cases happened at 2 hours,1.5 hours, 5 hours after the operation and 6 hours after having fever respectly. The vital signs and laboratory items got better gradually after those intervention measures above.The laboratory items changed slower than clinical items.The WBC changed firstly and followed by PCT and CRP. The slowest recovery of the laboratory items were the platelet and hemoglobin.4 cases discharged from hospital 8,13,12,6 days after the operation respectly. Conclusions:1. The clinical manifestations and laboratory outcome of urosepsis had a feature of diversity and non-specificity and reflected its feature of insidious onset.2. The clinical manifestations and laboratory outcome of urosepsis could change quickly in a short time,to make the disease rapidly onset3. Early diagnosis was the key to urosepsis, with particular emphasis on the WBC, vital signs, hemoglobin which could be the early warning signal.4. Early diagnosis and treatment could improve prognosis of urosepsis.