Evaluating the Complications and Risk of Urosepsis after Flexible Ureteroscopy in a Sodium-Glucose Co-transporter-2 Inhibitor Population with Heart Failure with Reduced Ejection Fraction.

Introduction: Recent guidelines highlight the significant role of sodium-glucose co-transporter-2 inhibitors (SGLT2is) in enhancing the overall condition of patients with heart failure with reduced ejection fraction (HFrEF), leading to their widespread use, but recent studies revealed an increased prevalence of urinary tract infections (UTIs) associated with this medication. The aim of the present study is to evaluate the risk of urosepsis after flexible ureteroscopy with flexible navigable vacuum assisted access sheath in patients diagnosed with renal stone disease who are using SGLT2i for HFrEF.

Materials and methods: This prospective comparative study included patients who were taking a SGLT2i (dapagliflozin 10 mg per day or empagliflozin 10 mg per day) for HFrEF and underwent flexible ureteroscopy in "Prof. Dr. Theodor Burghele" Clinical Hospital, Bucharest, Romania, between 01.01.2021 and 31.12.2024 for renal stone disease. All patients were completely assessed via imaging exam, complete blood count and urine analysis. The inclusion criteria were as follows: patients over 18 years old, established documented diagnosis of symptomatic HFrEF (Heart Failure New York Heart Association functional class II-IV), which has been present for at least two months and was optimally treated with pharmacological and/or device therapy, administration of SGLT2i, single-use flexible ureteroscopy, flexible and navigable vacuum-assisted ureteral access sheath (UAS) and the largest stone diameter less than 2 cm. The surgical technique met the same standard according to the recent recommendations of the International Alliance of Urolithiasis guideline on retrograde intrarenal surgery.

Results: Seventy-three patients who met the inclusion criteria were divided into two groups, according to previous SGLT2i administration, as follows: Group 1 (patients with SGLT2i) and Group 2 ( non-SGLT2i patients ). After analysing the demographic data, a slightly increased prevalence in female subjects was observed. There were no statistically different results regarding important pre-surgical data, such as mean stone dimension or density (HU), but there were preoperative differences regarding the prevalence of UTIs. After analyzing perioperative parameters such as mean previous JJ stented patients, mean surgical time and mean fluoroscopy time, the findings revealed no statistically significant differences. Regarding the main objective of the study, the present results revealed no differences in overall postoperative complications. There was a small number of postoperative urinary sepsis cases: three patients in Group 1 and two patients in Group 2.

Conclusion: Although SGLT2i administration may even increase the risk of developing UTIs, this does not influence the postoperative complications outcome after flexible ureteroscopy for renal stone disease. High-standard equipment such as single-use devices and suction ureteral access sheaths has a safe profile regarding sepsis occurrence even in UTIs, facilitating drug administration.