| ObjectivesTo evaluate and analyze the risk factors of urogenic sepsis after percutaneous nephrolithotripsy(PCNL)and flexible ureteroscopic lithotripsy(FURL),so as to provide some reference for the prevention of urogenic sepsis.MethodsSearch Pubmed,EMbase,Web of Science,and The Cochrane Library,CNKI,WanFang Data,The cqvip databases,SinoMed,etc.electronic databases,and to collect the literatures about the risk factors of sepsis after PCNL and FURL.The retrieval time is from the establishment of the database to October 2019.According to the detailed inclusion and exclusion criteria,the literature that conforms to the standard is included,and the literature quality evaluation standard of Newcastle-Ottawa Scale(NOS)is used to evaluate the quality of the included literature and extract the data.After that,Meta analysis is carried out with the Review Manager 5.2 software and Egger linear regression method in Stata is used to test the symmetry of the funnel chart,and quantitative methods are used to identify and judge the publication bias.Results1.Meta-analysis of the risk factors of urinary sepsis after PCNL selected 56 studies,including 36 in Chinese and 20 in English,with a total of 36814 subjects.The main outcome indicators of 12 risk factors were statistically significant,and their OR(95%CI)were as follows: gender(female)5.36 [4.25,6.77],age 2.71 [1.92,3.83],diabetes 4.16 [3.09,5.61],urinary tract infection 4.74 [3.86,5.82],staghorn stones 4.84 [2.88,8.13],urine culture positive 4.45 [3.55,5.60],infectious stones 3.96 [ 3.03,5.16],stone size 3.37 [2.78,4.08],no antibiotics before surgery 5.31 [1.32,21.28],operation time 3.50 [2.74,4.47],intraoperative lavage fluid> 23L: 2.87 [2.09,3.93],Intraoperative renal pelvis hypertension: 2.68 [1.52,4.72].The publication bias was tested by Egger’test.Except for the two factors of non-preoperative use of antibiotics and intraoperative renal pelvis hypertension,the P value of the rest of the research literature was > 0.01,and there was no obvious publication bias.2.The meta-analysis of risk factors for urosepsis after FURL operation was finally selected in 34 case-control studies,including 27 Chinese and 7 English,with a total of 13766 patients;the main outcome indicators were 14 risk factors,P <0.05,The difference is statistically significant,and their OR(95% CI)are: gender(female)2.75 [2.24,3.39],Age 1.84 [1.46,2.31],diabetes 3.38 [2.74,4.11],anatomical abnormalities of the urinary system: 3.20 [1.61,6.33],history of previous stone surgery: 2.76 [1.59,4.79],preoperative urinary tract obstruction: 3.22 [1.96,5.29],hydronephrosis: 4.02 [2.17,7.42],urinary tract infection: 5.64 [4.24,7.50],positive urine culture: 3.93 [3.03,5.11],infectious stones: 8.80 [5.64,13.73],stone size: 3.77 [2.59,5.50],no-antibiotics before surgery: 3.23 [1.87,5.61],operation time: 2.37 [1.85,3.05],intraoperative perfusion pressure: 3.36 [1.73,6.65].According to the Egger test,except for the abnormal anatomy of urinary system,previous stone operation history,hydronephrosis,no preoperative use of antibiotics,and perfusion pressure,the rest of the literature P > 0.01,there was no obvious publication bias.3.The risk factors of sepsis after PCNL and FURL combined with meta analysis showed that P<0.01,the difference was statistically significant;The inter-group heterogeneity of gender(female),infectious stone and operation time were 94%,89% and 80%,respectively.Age(> 60 years old),diabetes,urinary tract infection,middle urine culture(positive),no use of antibiotics before operation,stone size(PCNL group stone > 2.5cm,FURL group > 1.0cm),intra-group and inter-group heterogeneity were all less than 50%;The published bias test of the common risk factors of urinary sepsis after PCNL and FURL showed that except for the risk factor of stone size(P = 0.036),the other P > 0.05,there was no significant bias.Conclusions1.The meta-analysis of risk factors for sepsis after PCNL operation showed that: gender(female),age> 60 years,diabetes,urinary tract infection,infectious stones,staghorn stones,urine culture(Positive),no antibiotics before surgery,stone size,operation time,intraoperative perfusion volume,and intraoperative renal pelvis hypertension are risk factors for urinary sepsis after PCNL;2.The meta-analysis of risk factors for sepsis after FURL showed that: gender(female),age > 60 years,diabetes,urinary anatomical abnormalities,history of previous stone surgery,preoperative urinary tract obstruction,Hydronephrosis,urinary tract infection,infectious stones,urine culture(positive),no antibiotics before surgery,stone size,operation time and perfusion pressure are Risk factors for urogenital sepsis after FURL;3.Combined meta-analysis of risk factors for sepsis after PCNL and FURL: Age(> 60 years old),diabetes,urinary tract infection,middle urine culture(positive)and no use of antibiotics before operation were the common risk factors of the two operations. |
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