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Fever after shockwave lithotripsy--risk factors and indications for prophylactic antimicrobial treatment

Mordechai Duvdevani1, Gideon Lorber, Ofer N Gofrit

  • 1Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel. moti_duv@yahoo.com

Journal of Endourology
|December 31, 2009
PubMed
Abstract

Insights

Fever after shockwave lithotripsy (SWL) is uncommon (1.4%). Risk factors include positive urine culture, stents, kidney/upper ureteral stones, and pre-existing urinary tract infection or sepsis. Selective antibiotic use is advised.

Area of Science:

  • Urology
  • Infectious Disease

Background:

  • Shockwave lithotripsy (SWL) is a common procedure for kidney stones.
  • Fever is a potential complication following SWL.
  • Identifying risk factors can guide prophylactic strategies.

Purpose of the Study:

  • To determine risk factors for post-SWL fever.
  • To establish guidelines for prophylactic antimicrobial treatment.

Main Methods:

  • Analysis of 11,500 SWL treatments performed between 1985-2007.
  • Exclusion of stones >2 cm to minimize struvite stone influence.
  • Prospective registration of clinical parameters using a computerized database.

Main Results:

  • Fever (>38.0°C) occurred in 1.4% of patients.
  • Significant risk factors: positive urine culture, indwelling nephrostomy tube/stent, kidney/upper ureteral stones, symptomatic UTI, or sepsis.
  • No increased risk associated with mid/lower ureteral stones, stone size, or ureteral catheters.

Conclusions:

  • Prophylactic antibiotics are not universally indicated for SWL.
  • Selective prophylaxis recommended for patients with UTI, kidney/upper ureteral stones, or those requiring a nephrostomy tube/stent.

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