Pre-operative Urinary Evaluation Prior to Ureteroscopy and Post-operative Infection Rates
Daniel C. Leslie, PhD, Liz B. Wang, MD, Shaun E. Wason, MD, David S. Wang, MD.
Boston University School of Medicine, Boston, MA, USA.
BACKGROUND: Current AUA guidelines strongly recommend obtaining a urinalysis in all patients and urine culture in patients with suspected UTI or recurrent UTIs prior to ureteroscopy. Prior studies report positive urine culture results in 7.0 to 49.6 % of patients prior to ureteroscopy or PCNL for stone disease. We investigate the impact of urine culture results on the development of post-operative infectious complications in patients undergoing ureteroscopy for stone disease.
METHODS: We performed a single center retrospective study of patients undergoing ureteroscopy with laser lithotripsy for stone disease between January 2016 and December 2018. We reviewed the post-operative infectious complications (fever, sepsis, pyelonephritis) within 30 days of the procedure. Pre-operative urine culture results were stratified into negative (<10k CFU/mL), mixed flora (20-100k CFU/mL), or positive (>100k CFU/mL). Pre-operative urinalysis data (bacteria, leukocyte esterase, nitrites) was obtained for patients without pre-operative urine culture results.
RESULTS: 762 of 796 patients (96%) had urine culture results collected prior to ureteroscopy. Of those patients, 536 patients (70.3%) had a negative urine culture, 136 patients (17.8%) had mixed flora, and 90 patients (11.8%) had a positive urine culture. Patients were treated with antibiotics prior to the day of surgery in 98% of positive cultures, 31% of mixed flora, and 7% of negative cultures. Urine cultures were collected within 30 days of the procedure in the majority of patients (479 of 667; 71.8%), between 31 and 60 days in 127 patients (19.0%), and more than 60 days in 61 patients (9.1%). Of the 35 patients without urine culture results, 29 patients (83%) had a urinalysis prior to ureteroscopy which was negative for nitrite and leukocyte esterase in 100% and 86% of patients, respectively.
CONCLUSIONS: A large majority of patients in this single center study were pre-operatively evaluated for the presence of bacteria in urine according to AUA guidelines. Most patients with a positive culture were appropriately treated with pre-operative antibiotics, but there was inconsistency in treating mixed flora with pre-operative antibiotics. Rates of infectious complications were low in all 3 groups ranging from 2.9 to 3.3 %. 
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