Female sex, previous urinary tract infection (UTI), and longer operative time increase the risk for UTI following flexible ureteroscopy, despite preventive efforts, according to investigators.

Michael Baboudjian, MD, and colleagues at Conception Academic Hospital, Aix-Marseille University, Marseille, France retrospectively studied 604 patients who underwent flexible ureteroscopy from January 2015 to March 2019: 462 for stones and 142 for management of upper urinary tract urothelial carcinomas. Since 2015, the investigators noted, they had a protocol in place to avoid postoperative infections, including centralized collection of preoperative urine cultures that are examined daily by a urologist and a service provider; systematic use of ureteral access sheath; and use of standardized antibiotic prophylaxis. The cohort had a median age of 61 years (range 48-68 years) and included 268 female patients (44.4%).

Postoperative UTI occurred in 41 patients (6.7%). On multivariable analysis, female sex, UTI within the previous 6 months, and a preoperative polymicrobial urine culture were significantly associated with 2.2-, 2.3-, and 4.5-fold increased odds of postoperative UTI, respectively, Dr Baboudjian’s team reported in the World Journal of Urology. Longer operative times also was a risk factor, with each 1-minute increase in operative time significantly associated with 2% increased odds.

“Limiting operative time and improving our knowledge of polymicrobial urine cultures could reduce the infectious risk,” the authors concluded.

Reference

Baboudjian M, Gondran-Tellier B, Abdallah R, et al. Predictive risk factors of urinary tract infection following flexible ureteroscopy despite preoperative precautions to avoid infectious complications. World J Urol. 2019.  doi.org/10.1007/s0034