Risk factors for Infectious Complications of Ureteroscopy after Obstructive Acute Pyelonephritis

To identify risk factors for infectious complications of ureteroscopy after obstructive acute pyelonephri-tis (OAPN).Patients and

This single-center, retrospective cohort study (#20200002, retrospectively registered on February 1st, 2020) included patients who underwent emergency drainage for OAPN and subsequently underwent ureteroscopic stone removal between January 2006 and December 2020. Multivariable analysis was conducted using demographic and stone-related factors to determine those that could predict postoperative febrile urinary tract infection (UTI).

Overall, 432 patients underwent ureteroscopy after OAPN. The stone-free rate was 84.3%, whereas the overall and major complication rates were 17.6% and 3.2%, respectively. A total of 70 (16.2%) patients developed febrile UTIs, among whom 34 (7.9%) and 11 (2.5%) developed sepsis and severe sepsis, respectively. Multivaria-ble analysis identified diabetes mellitus [odds ratio (OR) 1.98, 95% confidence interval (CI) 1.05–3.74], duration from drainage to surgery >1 month (OR 2.28, 95% CI 1.20–4.74), and simultaneous retrograde intrarenal surgery (OR 2.96, 95% CI 1.35–6.48) as significant risk factors for UTI. After dividing patients into low- (0), intermedi-ate- (1), and high- (2–3) risk groups according to the number of factors they had, the risk of postoperative UTI was 6.3%, 14.5%, and 27.7%, respectively (p for trend <0.001).

Patients who underwent ureteroscopy after OAPN were at risk for postoperative UTI, despite its effi-cacy. Simultaneous retrograde intrarenal surgery should be carefully planned, especially for patients with diabetes mellitus or extended surgery wait times.