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Endoscopic Procedures V: ERCP

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Related Experiment Video

Updated: Jun 28, 2025

Technical Modification of the Terminal Ureter During Total Transperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma

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Published on: November 22, 2019

Ureterorenoscopic Stone Removal without Antibiotic Prophylaxis.

Maximilian Reinhard Müller¹, Eva-Maria Prey¹, Philipp Julian Spachmann²

¹Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Regensburg, Germany.

Urologia Internationalis

|April 16, 2024

Summary

Sparing routine antibiotic prophylaxis for ureterorenoscopy (URS) stone removal in patients with clear urine cultures is feasible, significantly reducing antibiotic use without increasing complications. Further prospective studies are needed.

Keywords:

Antibiotic prophylaxis Antibiotic stewardship Kidney stone Ureteric stone Ureterorenoscopy Urinary tract infection Urolithiasis

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Published on: February 10, 2023

Area of Science:

Urology
Infectious Disease Management
Surgical Outcomes

Background:

Antibiotic stewardship is crucial in preventing antimicrobial resistance.
Routine antibiotic prophylaxis in ureterorenoscopy (URS) for stone removal is common but may be overused.

Purpose of the Study:

To evaluate the feasibility and safety of omitting routine antibiotic prophylaxis in patients undergoing URS for stone removal.
To assess the impact on postoperative complications and overall antibiotic consumption.

Main Methods:

Retrospective, monocentric study comparing patients who received no antibiotic prophylaxis (NoPAP) with a historical cohort receiving standard prophylaxis (PAP).
Analysis focused on postoperative fever and Clavien complications.
Patients with unremarkable preoperative urine cultures were included in the NoPAP group.

Main Results:

No significant difference in postoperative fever (1% NoPAP vs. 2% PAP) or Clavien 1-3 complications (9% NoPAP vs. 6.2% PAP) was observed.
Overall antibiotic usage decreased from 100% in the PAP group to 8.3% in the NoPAP group.
Residual stone and high ASA score were risk factors for postoperative fever.

Conclusions:

Omitting routine antibiotic prophylaxis in URS for stone removal is feasible for patients with negative preoperative urine cultures.
This strategy effectively reduces antibiotic exposure.
Prospective validation is recommended to confirm these findings.