Which neurogenic bladder patients are at higher risk of sepsis after percutaneous nephrolithotomy?

To identify predictors of sepsis following percutaneous nephrolithotomy in patients with neurogenic bladder, without investigating causal pathways.

We retrospectively analyzed a consecutive sample of patients with neurogenic bladder who underwent percutaneous nephrolithotomy at our referral center between 2009 and 2020. We also systematically searched PubMed until February 2025 for studies that investigated neurogenic patients undergoing this procedure. We then performed a single-arm meta-analysis of postoperative sepsis, including our own data, and meta-regressions to search for predictors.

In our cohort, sepsis rate was 6% [1%; 19%], 2/36 patients. The Charlson Comorbidity Index was the only predictor (p = 0.02). In the meta-cohort (13 cohorts, 2,369 patients), the combined sepsis rate was 12% [7%; 17%], despite high heterogeneity (I² = 75%), with no evidence of publication bias (p = 0.09). We identified younger age (p = 0.04), non-urethral urinary diversions (p = 0.04)-particularly ileal conduits (p < 0.001)-and non-traumatic etiologies (p = 0.02), especially spina bifida (p = 0.009), as predictors of sepsis.

We recommend the development of a targeted antibiotic prophylaxis protocol, tailored to these predictors, for patients with neurogenic bladder undergoing percutaneous nephrolithotomy. We motivate further research on causal pathways.