Prolonged preoperative double J stenting increases post-ureteroscopy infectious complications

The clinical benefit of preoperative ureteric double J (JJ) stenting prior to ureterorenoscopy (URS) for uncomplicated urolithiasis remains debated. In cases requiring urgent decompression or delayed definitive treatment, JJ stenting is frequently employed. However, prolonged indwelling time may increase the risk of bacterial colonization and subsequent infectious complications, though evidence remains limited.

We conducted a retrospective, single-center study including 350 adult patients who underwent URS at the Department of Urology, Lausanne University Hospital (CHUV) between January and December 2023. The primary outcome was infectious complication, defined as the occurrence of ≥ 1 of the following within 30 days postoperatively: fever > 38.0 °C, systemic inflammatory response, hospitalization > 3 days with documented signs of infection, or readmission for urinary infection. Ten predefined clinical variables were analyzed using univariable and multivariable logistic regression to identify independent predictors of infectious failure.

Most patients (83%) had a stent in place at the time of surgery, and 78% received cefuroxime as prophylaxis. Infectious complications occurred in 29 patients (8.3%). Patients with infectious complications had significantly longer JJ stent dwell times (mean 63.9 vs. 36.3 days, p < 0.001). Multivariable analysis identified prolonged stent dwell time (OR 0.984 per day; 95% CI 0.973-0.995; p < 0.001) and neurogenic bladder (OR 0.871; 95% CI 2.196-6.739; p < 0.001) as independent risk factors for infectious failure. Subgroup analysis revealed a significant increase in infection rates when dwell time exceeded 60 days (p < 0.001).

Prolonged JJ stent dwell time and neurogenic bladder are independently associated with increased postoperative infectious complications after URS. Our findings support implementing fast-track surgical protocols to reduce stent duration, particularly avoiding delays beyond 60 days, to minimize infection-related morbidity.