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Preoperative urine culture with contaminants is not associated with increased risk for urinary tract infection after ureteroscopic stone treatment

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Abstract

Purpose

We aimed to assess whether the presence of contaminants in the pre-operative urine culture (preop-UC) predicts postoperative urinary tract infection (postop-UTI) in patients undergoing elective ureteroscopy with laser lithotripsy.

Methods

A retrospective chart review was performed from 01/2019 to 12/2021 examining patients with unilateral stone burden ≤ 2 cm who underwent ureteroscopy with laser lithotripsy and had a preop-UC within 3 months. Positive, negative, contaminated, and polymicrobial definitions for UCs were established in accordance with current guidelines. Patients with positive and polymicrobial cultures were excluded. Postop-UTI was defined as the presence of urinary symptoms and a positive UC within 30 days of the procedure. Multivariable logistic regression models were utilized to evaluate risk factors for contamination in the preop-UC and the risk of postop-UTI.

Results

A total of 201 patients met the inclusion–exclusion criteria. Preop-UC was negative in 153 patients and contaminated in 48 patients. Significant contaminant-related factors included female gender and increased BMI. Postop-UTI was diagnosed in 3.2% of patients with negative preop-UCs and 4.2% of patients with contaminants, with no difference between groups (p = 0.67). The regression model determined that the presence of contaminants in preop-UC failed to predict postop-UTI (OR 0.69, p = 0.64).

Conclusion

The presence of contaminants in preop-UCs is not associated with an increased risk of postop-UTIs after ureteroscopy. Our study supports that contaminants in the preop-UC can be interpreted as a negative UC in terms of postop-UTI risk stratification. Preoperative antibiotics should not be prescribed for patients undergoing uncomplicated ureteroscopy for stone surgery in the setting of a contaminated preop-UC.

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Data availability

The data supporting the findings of this study are available upon request. We, the research group, are committed to fostering transparency and scientific rigor. Interested parties may contact the senior author (Wilson Molina MD) to access the relevant datasets and supplementary materials associated with this publication. We believe in promoting open science and are enthusiastic about sharing our research resources to facilitate further collaboration and scrutiny.

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Authors and Affiliations

  1. Department of Urology, The University of Kansas Health System, Kansas City, KS, USA

    Willian Ito, Crystal Valadon, Bristol B. Whiles & Wilson R. Molina

  2. School of Medicine, The University of Kansas, Kansas City, KS, USA

    Nicholas Choi, George Letner, Nicholas Genz & Dillon Prokop

  3. Department of Biostatistics and Data Science, University of Kansas, 3901 Rainbow Boulevard, Mail Stop #3016, Kansas City, KS, 66160, USA

    Mihaela E. Sardiu & Holly Smith

Authors
  1. Willian Ito
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  2. Nicholas Choi
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  3. George Letner
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  4. Nicholas Genz
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  5. Dillon Prokop
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  6. Crystal Valadon
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  7. Mihaela E. Sardiu
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  8. Holly Smith
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  9. Bristol B. Whiles
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  10. Wilson R. Molina
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Contributions

IWE: protocol/project development, data collection or management, data analysis, manuscript writing/editing. CN: data collection or management. LG: data collection or management. PDJ: data collection or management. GN: data collection or management. VC: manuscript writing/editing. SM: data analysis. SH: data analysis. WBB: manuscript writing/editing. MW: manuscript writing/editing, protocol/project development.

Corresponding author

Correspondence to Wilson R. Molina.

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Conflict of interest

Wilson R. Molina is a consultant for Olympus, Boston Scientific, Johnson & Johnson, IPG, and Fortec. All other authors have no additional disclosures.

Research involving human participants and/or animals

This retrospective study was approved by the University of Kansas Medical Center’s Institutional Review Board (IRB Protocol Number: STUDY00144857, title: “The Impact of Endourological Diseases and Management: Experience at University of Kansas Medical Center”) and performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

As a retrospective case–control study, a waiver for HIPAA authorization, thereby consent to participate, was requested and granted by the local Institutional Review Board (protocol number STUDY00144857, title: “The Impact of Endourological Diseases and Management: Experience at University of Kansas Medical Center”).

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Ito, W., Choi, N., Letner, G. et al. Preoperative urine culture with contaminants is not associated with increased risk for urinary tract infection after ureteroscopic stone treatment. World J Urol 42, 159 (2024). https://doi.org/10.1007/s00345-024-04793-w

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