Post-ureteroscopy febrile urinary tract infections are linked to pre-operative stent dwell time: Results from three European endourology centres

ABSTRACT

Introduction & Objectives: Indwelling ureteric stents are valuable devices used in emergency drainage of upper urinary tract obstruction due to ureteric stones. However, stents can cause significant morbidity with infections, encrustations and blockages. In the study we look at the outcomes of pre-operative stent dwell time on infectious complications following ureteroscopy and laser fragmentation (URSL). Materials & Methods: Data was retrospectively collected for outcomes of URSL from 3 European endourology centres for patients with preoperative indwelling ureteric stents. We included data for patient details, stone demographics, operative details, stone free rate (SFR), outcomes and complications between 2011 and 2020. Patients were divided into two groups based on the stent dwell time group 1 (<6 months) and group 2 (≥6 months). Descriptive statistics were used to determine the rate of early post-operative infectious complications (defined as the presence of fever?) and ICU access. Binomial logistic regression analysis were used to explore the relationship between stent dwelling time and post-operative early infectious complications. (SPSS v.24). Results: There were 501 patients undergoing URSL in the study period, with 429 and 72 patients in groups 1 and 2 respectively (Table 1). The mean age and operative time in groups 1 and 2 were 71±30 years and 64±22 years, and 51±28 minutes and 59±31 minutes respectively. Infectious complications and ICU admissions were seen in 32 (8%) and 3 (0.7%), and 22 (31%) and 1 (1.4%) in groups 1 and 2 respectively. Stent dwell time of ≥6 months carried significantly higher risk for febrile UTI post URSL (RR=5.45, 95% CI 2.94-10.10, p<0.001). (Table Presented) Conclusions: Although the overall risk of infectious complication rates from URSL were low, longer indwelling stent time significantly increases the risk of post-operative infections, of which a small proportion of patients end up in ICU. We would recommend having the stent dwell time as short as possible and not to exceed a 6 months’ time period, and our findings will help prioritise these patients in the post-COVID era.