Document Type : Research articles


Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran


Background: Transurethral ureterolithotripsy (TUL) is a common and highly efficient procedure for treating ureteral stones. The need for preoperative antibiotic prophylaxis to prevent post-TUL infections remains controversial.
Objectives: This study aimed to investigate whether the removal of preoperative antibiotic prophylaxis affects the rate of postoperative complications in patients undergoing TUL.
Methods: A total of 62 patients (aged 15-65 years) undergoing TUL between November 2021 and March 2022 were included in this controlled clinical trial. Patients were divided into two groups by the available gradual and sequential sampling methods: 33 had positive preoperative urine culture (UC), and 29 had negative preoperative UC. None of the patients in the two groups received preoperative antibiotic prophylaxis. Perioperative and postoperative outcomes, such as the operative time, stone-free rate, postoperative analgesic use, fever, urinary tract infection (UTI), and hospital stay, were reviewed in both groups.
Results: Patients with positive UC were significantly older than those with negative UC (P=0.018), and had a higher BMI (P=0.016). No significant differences were observed between the two groups in most perioperative variables or postoperative outcomes (P>0.05). In addition, patients in the positive UC group had significantly more underlying diseases than the other group (P=0.022). Postoperative symptomatic UTI was found in neither of the two groups. Fever was reported in 3 (9.1%) and 1 (3.4%) patients in the positive and negative UC groups, respectively, with no statistically significant differences between the two groups (P=0.616). In the matched logistic regression model, the effect of preoperative UC on postoperative fever was not significant (P=0.40).
Conclusion: The results of our study showed that prophylactic antibiotics can be eliminated at the discretion of the surgeon in patients without symptomatic positive UC.


  1. Deng T, Liu B, Duan X, Cai C, Zhao Z, Zhu W, et al. Antibiotic prophylaxis in ureteroscopic lithotripsy: a systematic review and meta‐analysis of comparative studies. BJU Int. 2018;
  2. (1):29-39. doi: 10.1111/bju.14101. [PubMed: 29232047].
  3. Aghamir SM, Hamidi M, Salavati A, Mohammadi A, Farahmand H, Meysamie AP, et al. Is antibiotic prophylaxis necessary in patients undergoing ureterolithotripsy? Acta Med Iran. 2011;49(8):513-6. [PubMed: 22009806].
  4. Knopf HJ, Graff HJ, Schulze H. Perioperative antibiotic prophylaxis in ureteroscopic stone removal. Eur Urol. 2003;44(1):115-8. doi: 10.1016/s0302-2838(03)00189-1. [PubMed: 12814685].
  5. Allameh F, Razzaghi M, Fallah-Karkan M, Hosseini B, Azar AT, Ranjbar A, et al. Comparison of stone retrieval basket, stone cone and holmium laser: which one is better in retropulsion and stone-free status for patients with upper ureteral calculi? J Lasers Med Sci. 2019;10(3):179-84. doi: 10.15171/jlms.2019.28. [PubMed: 31749942].
  6. Takahashi T, Somiya S, Ito K, Haitani T, Higashi Y, Yamada H, et al. Risk factors for febrile urinary tract infection after transurethral ureterolithotripsy: analysis of treatment outcomes of 1,235 patients at a single center. Hinyokika Kiyo. 2022;68(6):171-8. doi: 10.14989/ActaUrolJap_68_6_171. [PubMed: 35850505].
  7. Takahashi S, Takeyama K, Miyamoto S, Tanuma Y, Takagi Y. Surgical antimicrobial prophylaxis in transurethral ureterolithotripsy. J Infect Chemother. 2005;11(5):239-43. doi: 10.1007/s10156-005-0401-3. [PubMed: 16258820].
  8. Scotland KB, Lange D. Prevention and management of urosepsis triggered by ureteroscopy. Res Rep Urol. 2018;10:43-49. doi: 10.2147/RRU.S128071. [PubMed: 30013956].
  9. Pricop C, Dorobăt C, Puia D, Orsolya M. Antibiotic prophylaxis in retrograde ureteroscopy: what strategy should we adopt? Germs. 2013;3(4):115-21. doi: 10.11599/germs.2013.1045. [PubMed: 24432295].
  10. Khusid JA, Hordines JC, Sadiq AS, Atallah WM, Gupta M. Prevention and management of infectious complications of retrograde intrarenal surgery. Front Surg. 2021;8:718583. doi: 10.3389/fsurg.2021.718583. [PubMed: 34434958].
  11. Gopalakrishnan PP, Shukla SK, Tak T. Antibiotic prophylaxis and anaphylaxis. Clin Med Res. 2010;8(2):80-1. doi: 10.3121/cmr.2010.929. [PubMed: 20660929].
  12. Zisman A, Badaan S, Kastin A, Kravtsov A, Amiel GE, Mullerad M. Tailoring antibiotic prophylaxis for ureteroscopic procedures based on local resistance profiles may lead to reduced rates of infections and urosepsis. Urol Int. 2020;104(1)1:106-12. doi: 10.1159/000503905. [PubMed: 31743924].
  13. Lo CW, Yang SS, Hsieh CH, Chang SJ. Effectiveness of prophylactic antibiotics against post-ureteroscopic lithotripsy infections: systematic review and meta-analysis. Surg Infect. 2015;16(4):415-20. doi: 10.1089/sur.2014.013. [PubMed: 26207401].
  14. Chew BH, Flannigan R, Kurtz M, Gershman B, Arsovska O, Paterson RF, et al. A single dose of intraoperative antibiotics is sufficient to prevent urinary tract infection during ureteroscopy. J Endourol. 2016;30(1):63-8. doi: 10.1089/end.2015.0511. [PubMed: 26413885].
  15. Mama RK, Al-bazzaz PH, Al-Ibraheem NP. A comparative study between a single dose pre-induction antibiotic versus continuous antibiotics to prevent urinary tract infection
  16. during ureteroscopy. Trends Med. 2018;18(6):1-4. doi: 10.15761/TiM.1000162.
  17. Lopez VM, Llopis JA, Lopez ME, Rubias CC, Serra AC, de Paz Cruz L, et al. Urinary bacteriologic study prior to endoscopic urologic surgery. Actas Urol Esp. 2005;29(7):667-75. doi: 10.1016/s0210-4806(05)73317-9. [PubMed: 16180317].
  18. Li MW, Lee YJ. Comparison of prophylactic antibiotics in patients without pyuria undergoing ureterorenoscopic surgery. Urol Sci. 2020;31(5):216-20. doi: 10.4103/UROS.UROS_40_20.
  19. Bootsma AM, Laguna Pes MP, Geerlings SE, Goossens A. Antibiotic prophylaxis in urologic procedures: a systematic review. Eur
  20. Urol. 2008;54(6):1270-86. doi: 10.1016/j.eururo.2008.03.033. [PubMed: 18423974].
  21. Ramos-Castaneda JA, Ruano-Ravina A, Munoz-Price LS, Toro-Bermúdez R, Ruiz-Londoño D, Segura-Cardona AM, et al. Risk of infection in patients undergoing urologic surgery based on the presence of asymptomatic bacteriuria: A prospective study. Am J Infect Control. 2019;47(12):1474-8. doi: 10.1016/j.ajic.2019.06.024. [PubMed: 31375294].
  22. Hsieh CH, Yang SS, Lin CD, Chang SJ. Are prophylactic antibiotics necessary in patients with preoperative sterile urine undergoing ureterorenoscopic lithotripsy? BJU Int. 2014;113(2):275-80. doi: 10.1111/bju.12502. [PubMed: 24127851].