Post-operative Urinary Tract Infection After Pediatric Pyeloplasty: A Multicenter Analysis of Drain Type, Surgical...

To determine whether antibiotic prophylaxis at discharge reduces post-operative urinary tract infection (UTI) after pediatric pyeloplasty, and to identify independent predictors of infection.

We retrospectively reviewed 435 consecutive patients who underwent pyeloplasty at two pediatric urology centers. Post-operative UTI was defined as a culture-proven infection accompanied by fever or urinary symptoms; asymptomatic bacteriuria was excluded. Univariate comparisons used chi-square, Fisher's exact and Mann-Whitney U tests. A multivariable logistic regression model with Wald-based confidence intervals identified independent predictors; collinearity was assessed by variance inflation factors and confirmed by sensitivity, interaction and surgical-era analyses.

UTI occurred in 80 patients (18.4%). Drain type was the strongest predictor (p=0.003): 14.8% with double-J stent (DJS) alone, 26.6% with Pippi Salle external stent and 35.1% with combined DJS+PCN. Both externalized configurations remained independent risk factors after adjustment (OR 1.77, 95% CI 1.18-2.68, p=0.006; OR 1.63, 95% CI 1.21-2.21, p=0.001). Pelvic reduction was independently protective (OR 0.52, 95% CI 0.30-0.88, p=0.015). Open surgery was significant on univariate analysis (25.5% vs. 15.0%, p=0.011) but not after adjustment (OR 1.34, p=0.302). Prophylaxis, prescribed in 168 patients (38.6%), showed no association with infection (OR 0.96, p=0.781) and no benefit within any drainage subgroup. Drain duration was not associated with infection.

Drainage configuration, not antibiotic prophylaxis, is the principal determinant of infection risk after pediatric pyeloplasty. Routine post-discharge prophylaxis confers no measurable benefit and may reasonably be withheld in patients managed with an internal stent, supporting a risk-stratified approach guided by drain selection.