Prolonged Preoperative Double J Stenting Increases Post-Ureteroscopy Infectious Complications

Prolonged Preoperative Double J Stenting Increases Post-Ureteroscopy Infectious Complications | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prolonged Preoperative Double J Stenting Increases Post-Ureteroscopy Infectious Complications Matteo Ortolini, Audrey Masnada, François Crettenand, Kevin Stritt This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7231302/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 Oct, 2025 Read the published version in World Journal of Urology → Version 1 posted 13 You are reading this latest preprint version Abstract Background 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. Methods 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, or readmission for urinary infection. Ten predefined clinical variables were analyzed using univariable and multivariable logistic regression to identify independent predictors of infectious failure. Results 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). Conclusion 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. Figures Figure 1 Figure 2 Key Points nephrolithiasis, double J stenting, infectious complications Introduction Urolithiasis is a common and increasingly prevalent condition worldwide. In the United States, the estimated lifetime prevalence of kidney stones is approximately 12% in men and 10% in women [ 1 – 3 ]. Beyond being a frequent cause of acute flank pain and emergency department visits, kidney stones are associated with substantial healthcare costs, high recurrence rates, and a significant decline in patient quality of life [ 4 – 6 ]. Despite the availability of effective treatment options, long-term management remains challenging due to frequent recurrences. When surgical intervention is warranted, ureterorenoscopy (URS) is a widely adopted and effective modality for stone removal. In many cases—particularly in the setting of obstructive uropathy or infection—temporary ureteric double J (JJ) stenting is employed preoperatively to decompress the urinary tract and facilitate access during URS. However, procedural delays due to logistical or institutional constraints can lead to prolonged stent indwelling, which may increase the risk of bacterial colonization, urinary tract infection, and postoperative infectious complications [ 7 – 10 ]. Notably, preoperative JJ stent dwell times exceeding two months have been independently associated with a significantly higher incidence of febrile urinary tract infections after URS [ 7 , 8 ]. These findings emphasize the need to minimize stent duration as part of an optimized strategy to reduce infection-related morbidity in endourological practice. The objective of this study was to evaluate whether prolonged preoperative JJ stenting is independently associated with an increased risk of postoperative infectious complications following URS. Identifying this potential risk factor could support the implementation of fast-track surgical pathways aimed at reducing unnecessary stent dwell time and improving clinical outcomes. Materials and Methods We conducted a retrospective, single-center study in the Department of Urology at Lausanne University Hospital (CHUV), Switzerland. It included all patients who underwent URS between January 1 and December 31, 2023. Data were extracted from the hospital’s secure electronic medical records system (Soarian® Clinicals, Cerner Corporation, Kansas City, MO, USA), which records demographic, clinical, laboratory, radiological, and operative data as part of routine care. No additional data or biological samples were collected for this study. The study population consisted of adult patients who underwent URS, regardless of sex or age. Only patients with complete medical records documenting preoperative urine culture results, duration of JJ stenting, intraoperative parameters, and postoperative follow-up were included. Patients with calculi at any location within the ureter or kidney were considered eligible, provided they were legally competent adults at the time of the intervention. Exclusion criteria included deceased individuals, patients who explicitly refused the use of their data for research, and cases lacking diagnostic certainty. The primary outcome was defined as infectious complication within 30 days post-URS, corresponding to the occurrence of one or more of the following: fever > 38.0°C, systemic inflammatory response, hospitalization > 3 days, or readmission for urinary tract infection. We assessed the association between infectious failure and ten predefined clinical variables: age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) score, presence of urinary tract anomalies, neurogenic bladder, indication (urolithiasis vs malignancy), preoperative positive urine culture, operative time, and duration of preoperative JJ stenting (dwell time). Statistical analysis included descriptive statistics to summarize patient demographics, clinical characteristics, and complication rates. Comparative analyses were conducted using chi-square tests for categorical variables and Student’s t -tests or nonparametric equivalents for continuous variables, depending on data distribution. Univariable and multivariable logistic regression models were then conducted to identify independent predictors of infectious complications. All regression analyses were performed using Stata version 17.0 (StataCorp LLC, College Station, TX, USA). A two-sided p -value < 0.05 was considered statistically significant. To assess the impact of stent dwell time on infectious outcomes, patients were stratified into three groups based on dwell duration: 60 days. Group comparisons were performed using contingency tables with chi-square tests to evaluate differences in infection rates across categories. Results A total of 350 patients who underwent URS during the study period were included in the analysis. The median age was 56 years (IQR 44–69), and 244 patients (70%) were male. The median body mass index (BMI) was 26.8 kg/m² (IQR 23.8–30.5). Regarding ASA classification, 42 patients (12%) were ASA I, 219 (63%) ASA II, 83 (24%) ASA III, and 6 (2%) ASA IV. Urological comorbidities were present in several patients, with 23 individuals (7%) having urinary tract anomalies. These included ureteropelvic junction (UPJ) obstruction in 5 cases (22%), ureteral malformation in 10 cases (43%), cystectomy with urinary diversion in 2 cases (9%), kidney transplant in 3 cases (13%), and other causes in 3 cases (13%). Eight patients (2%) had neurogenic bladder, six of whom (75%) required bladder catheterization. The primary indication for URS was urolithiasis, accounting for 316 patients (90%), of whom 178 (56%) presented with a first episode and 138 (44%) with recurrent stones. Urogenital malignancy was the indication in 34 cases (10%). Baseline demographic characteristics, urological comorbidities, and indications for URS are summarized in Table 1. Preoperative urinary culture was available for 303 patients (87%) (Table 2 and Figure 1). Among these, 190 (63%) had sterile urine, and 53 (17%) showed contamination. The most frequently identified pathogens were Escherichia coli (5%) and Enterococcus faecalis (4%), followed by Pseudomonas aeruginosa (2%). The median time from culture to URS was 7 days (IQR 7–11). Regarding surgical approach, rigid URS was performed in 133 patients (38%), flexible URS in 126 (36%), and a combined rigid and flexible procedure in 91 patients (26%). At the time of URS, a JJ stent was in place in 289 cases (83%), while 61 patients (17%) underwent the procedure without prior stenting. Antibiotic prophylaxis was administered in accordance with institutional guidelines. The most used agents were cefuroxime in 272 patients (78%), followed by amoxicillin/clavulanic acid (7%), ceftriaxone (5%), and other less frequently used antibiotics including sulfamethoxazole/trimethoprim, piperacillin-tazobactam, ciprofloxacin, gentamycin, clindamycin, ertapenem, vancomycin, fluconazole, amikacin, and norfloxacin. The median operative time was 44 minutes (IQR 31–62) (Table 3). Postoperative infectious complications occurred in 29 patients (8.3%) (Table 4). Among these, 7 patients (2%) experienced fever >38.0°C, 8 patients (2%) showed systemic inflammatory response, 22 patients (6%) required hospitalization for more than 3 days, and 9 patients (3%) were readmitted within 30 days due to infection. Univariable and multivariable logistic regression analyses were performed to identify predictors of infectious complication. In multivariable analysis, prolonged JJ stent dwell time was independently associated with an increased risk of infection (OR 0.984 per day; 95% CI 0.973–0.995; p<0.001), as was the presence of a neurogenic bladder (OR 0.871; 95% CI 2.196–6.739; p<0.001). Other variables, including age, BMI, ASA score, urinary tract anomalies, and positive urine culture, did not remain significant in multivariable analysis. Full regression results are provided in Table 5. To further evaluate the impact of stent dwell time on infectious complications, patients were stratified into three groups based on stent duration: 60 days. Infectious complication occurred in 6.0% of patients with dwell time <30 days, 5.5% in the 31–60 day group, and 21.4% in those with stents left in place for more than 60 days. A Chi-square test revealed a statistically significant difference in infection rates between these groups (χ² = 9.26, p = 0.0098), suggesting that prolonged stent indwelling time, particularly beyond 60 days, is associated with a higher risk of postoperative infectious complications. These findings are summarized in Table 6 and Figure 2. Discussion This study investigated the relationship between preoperative JJ stent dwell time and the risk of infectious complications following URS. Our results demonstrate that prolonged stent duration is significantly associated with increased postoperative infectious failure, with a particularly notable rise in infection risk beyond 60 days of indwelling time. The findings align with previous reports suggesting that indwelling stents act as a nidus for bacterial colonization, increasing the risk of urinary tract infections and sepsis following endourological procedures. In our cohort, patients with stent dwell times exceeding two months experienced a more than threefold higher rate of infectious complications compared to those with shorter durations. This reinforces earlier studies identifying prolonged stenting as a modifiable risk factor for infection, particularly in high-risk populations [7–10]. Our multivariable analysis further identified neurogenic bladder as an independent predictor of infectious failure. This is consistent with existing literature, where impaired bladder emptying, detrusor dysfunction, and chronic catheterization are well-established contributors to urinary tract infections and postoperative sepsis [11–13]. Neurogenic bladder alters normal voiding dynamics and often necessitates intermittent or indwelling catheterization, both of which facilitate bacterial colonization and biofilm formation [12]. Although other factors such as positive preoperative urine cultures and higher ASA scores showed statistical significance in univariable analyses, their effects were attenuated in multivariable models, highlighting the predominant influence of stent dwell time and neurogenic dysfunction in driving postoperative infectious outcomes. Importantly, our subgroup analysis showed a statistically significant difference in infection rates across dwell time categories (60 days), suggesting that a threshold effect may exist. This observation is supported by prior studies demonstrating that JJ stent indwelling beyond 60 days is associated with higher rates of urinary tract infections, febrile episodes, and complications during URS [14–16]. This stratification may serve as a practical clinical tool to guide surgical planning. Reducing stent dwell times where feasible—ideally limiting preoperative stenting to under two months—may reduce infection-related morbidity and healthcare burden [14,17]. These findings have direct implications for clinical practice. First, they emphasize the need for streamlined scheduling and prioritization of definitive stone treatment in patients with indwelling JJ stents. Second, they support the development of institutional “fast-track” URS protocols aimed at minimizing unnecessary stent dwell time. Finally, they underscore the importance of careful monitoring and preoperative optimization, particularly in patients with complex urinary tract anatomy or neurogenic bladder. This study has several important limitations. First, its retrospective, single-center design introduces potential selection, information, and observer biases that may have influenced the findings. Although clinical, surgical, and microbiological data were extracted from a well-maintained electronic health record system, retrospective analyses inherently lack control over data completeness and uniformity. Second, some relevant clinical parameters—such as stone burden, stone composition, and precise microbial resistance profiles—were not included in the multivariable analysis. These factors have been previously shown to influence infectious outcomes following URS and could confound the associations observed in this study [18,19]. Third, although most patients received cefuroxime as per institutional prophylactic guidelines, the antibiotic regimen was not uniformly standardized across all cases. This variability in prophylaxis may have influenced postoperative infection rates, especially in patients harboring resistant organisms. Standardizing antibiotic protocols and incorporating resistance data could enhance future analyses [20]. Finaly, our study population exhibited a sex imbalance, with men comprising 70% of the cohort. This overrepresentation reflects the known epidemiological pattern of higher urolithiasis prevalence in men [21], but it may limit the external validity of our findings, particularly for female patients who may present different risk profiles and stent-related symptomatology [17]. Conclusion Prolonged indwelling time of JJ ureteral stents is an independent and clinically significant risk factor for postoperative infectious complications following URS. These findings underscore the importance of minimizing stent dwell time through expedited surgical scheduling and support the development of structured, fast-track care pathways. Implementing such protocols may contribute to reducing infection-related morbidity, improving patient outcomes, and optimizing resource utilization in endourological practice. Declarations Acknowledgement The authors would like to thank the Department of Urology at Lausanne University Hospital (CHUV) for their support in facilitating this study. We are particularly grateful to the clinical and administrative staff for their assistance in data collection and patient follow-up. No external funding was received for this study. Consent for Publication Not applicable. Competing Interests The authors declare no competing interests. Funding No funding was received for this study. Author’s contribution Conceptualization: Kevin Stritt, Matteo Ortolini. Data curation: Kevin Stritt. Formal analysis: Kevin Stritt, Matteo Ortolini. Funding acquisition: Kevin Stritt. Investigation: Kevin Stritt, Matteo Ortolini. Methodology: Kevin Stritt, Matteo Ortolini. Project administration: Kevin Stritt. Resources: Kevin Stritt. Software: Kevin Stritt. Supervision: Kevin Stritt, Matteo Ortolini. Validation: Kevin Stritt. Visualization: Kevin Stritt. Writing–original draft: Kevin Stritt. Writing–review & editing: Matteo Ortolini, François Crettenand, Audrey Masnada. Availability of Data and Materials The datasets used and analyzed during the current study are available from the corresponding author on reasonable request. Author disclosure The authors declare that they have no conflicts of interest related to this work. No competing financial interests exist. No external funding was received for the conduct of this study or the preparation of this manuscript. References Romero V, Akpinar H, Assimos DG. Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol . 2010;12(2-3):e86–96. Scales CD Jr, Smith AC, Hanley JM, Saigal CS; Urologic Diseases in America Project. Prevalence of kidney stones in the United States. Eur Urol . 2012;62(1):160–5. Abufaraj M, Xu T, Cao C, Siyam A, Waldhoer T, Mari A, et al. Prevalence and trends in kidney stone among adults in the USA: analyses of National Health and Nutrition Examination Survey 2007–2018 data. Eur Urol Focus . 2021;7(6):1468–75. Ferraro PM, Curhan GC, D'Addessi A, Gambaro G. Risk of recurrence of idiopathic calcium kidney stones: analysis of data from the literature. J Nephrol . 2017;30(2):227–33. New F, Somani BK. A complete world literature review of quality of life (QOL) in patients with kidney stone disease (KSD). Curr Urol Rep . 2016;17(12):88. Saigal CS, Joyce G, Timilsina AR; Urologic Diseases in America Project. Direct and indirect costs of nephrolithiasis in an employed population: opportunity for disease management? Kidney Int . 2005;68(4):1808–14. Geraghty RM, Pietropaolo A, Skolarikos A, et al. Post-ureteroscopy infections are linked to pre-operative stent dwell time over two months: outcomes of three European Endourology centres. J Clin Med. 2022;11(1):147. Nevo A, Mano R, Baniel J, Lifshitz D. Ureteric stent dwelling time: a risk factor for post-ureteroscopy sepsis. BJU Int. 2017;119(1):117–22. Ülker V, Yılmaz N, Ağuş N, et al. Bacterial colonization of ureteral double-J stents in patients with negative urine culture. J Urol Surg. 2019;6(2):125–9. Shi YF, Ju WL, Zhu YP, et al. The impact of ureteral stent indwelling time on the treatment of acute infection caused by ureteral calculi. Urolithiasis. 2017;45(6):579–83. Weld KJ, Dmochowski RR. Effect of bladder management on urological complications in spinal cord injured patients. J Urol. 2000;163(3):768–772. Groah SL, Weitzenkamp D, Lammertse DP, et al. Excess risk of bladder cancer in spinal cord injury: Evidence for an association between indwelling catheter use and bladder cancer. Arch Phys Med Rehabil. 2002;83(3):346–351. Nicolle LE. Catheter-related urinary tract infection. Drugs Aging. 2005;22(8):627–639. Nevo A, Mano R, Baniel J, et al. The impact of ureteral stent dwelling time on infectious complications following ureteroscopy: a multi-institutional study. J Endourol. 2020;34(4):427–431. Kawahara T, Ito H, Terao H, et al. Ureteral stent encrustation, incrustation, and coloring: morbidity related to indwelling times. J Endourol. 2012;26(2):178–182. Aboumarzouk OM, Kata SG. Ureteroscopic management of ureteric stones: a meta-analysis of literature. Arab J Urol. 2016;14(1):29–38. Türk C, Neisius A, Petřík A, et al. EAU Guidelines on Urolithiasis. Eur Urol. 2022. [Available at: https://uroweb.org/guidelines/urolithiasis] Taylor E, Miller J, Chi T, Stoller ML. Complications associated with ureteral stents. Int Urol Nephrol. 2012;44(3):905–913. Berardinelli F, Proietti S, Cindolo L, et al. Infective complications after retrograde intrarenal surgery: a new standardized classification system. Int Urol Nephrol. 2016;48(11):1757–1762. Hooton TM, Gupta K. Antimicrobial prophylaxis: optimizing strategies for prevention of urinary tract infections. Clin Infect Dis. 2019;68(11):1952–1959. Scales CD Jr, Smith AC, Hanley JM, Saigal CS. Prevalence of kidney stones in the United States. Eur Urol. 2012;62(1):160–165. Tables Table 1 – Baseline Demographic, Urological Comorbidities, and Indications for URS Characteristic Total (N=350) Median age – yr (IQR) 56 (44–69) Sex, male – no. (%) 244 (70) Sex, female – no. (%) 106 (30) Median BMI – kg/m² (IQR) 26.8 (23.8–30.5) ASA score – no. (%) 1 42 (12) 2 219 (63) 3 83 (24) 4 6 (2) Urological comorbidities Urinary tract anomalies – no. (%) 23 (7) UPJ obstruction 5 (22) Ureteral malformation 10 (43) Cystectomy with diversion 2 (9) Kidney transplant 3 (13) Other 3 (13) Neurogenic bladder – no. (%) 8 (2) With bladder catheterization – no. (%) 6 (75) Indications for URS – no. (%) Urolithiasis 316 (90) First episode 178 (56) Recurrence 138 (44) Urogenital cancer 34 (10) Data are presented as number (percentage) or median (interquartile range, IQR), as appropriate. BMI: body mass index; ASA: American Society of Anesthesiologists score; UPJ: ureteropelvic junction; URS: ureterorenoscopy. Table 2 – Urinary Culture Results Urinary Culture Total (N=350) Pathogen identified: Sterile culture 190 (63) Contamination 53 (17) Escherichia coli 14 (5) Enterococcus faecalis 12 (4) Pseudomonas aeruginosa 5 (2) Klebsiella pneumoniae group 4 (1) Candida albicans 3 (1) Citrobacter koseri 3 (1) Staphylococcus aureus 2 (1) Serratia marcescens group 1 (0) Proteus mirabilis 1 (0) Polymicrobial culture 15 (5) Median time from culture to URS – days (IQR) 7 (7–11) Data are presented as number (percentage) or median (interquartile range, IQR), as appropriate. URS: ureterorenoscopy. Contamination refers to mixed flora or non-uropathogenic isolates not meeting criteria for true infection. "Polymicrobial culture" includes samples with two or more distinct uropathogens. Table 3 – Interventions Intervention Details Total (N=350) URS Approach – no. (%) Rigid 133 (38) Flexible 126 (36) Rigid + Flexible 91 (26) JJ Stent in Situ – no. (%) Yes 289 (83) No 61 (17) Antibiotic Prophylaxis – no. (%) Cefuroxime 272 (78) Amoxicillin/Clavulanic Acid 26 (7) Ceftriaxone 16 (5) Sulfamethoxazole/Trimethoprim 7 (2) Piperacillin-tazobactam 7 (2) Ciprofloxacin 6 (2) Gentamycin 5 (1) Clindamycin 3 (1) Ertapenem 2 (1) Vancomycin 2 (1) Fluconazole 2 (1) Amikacin 1 (0) Norfloxacin 1 (0) Median Operative Time – min (IQR) 44 (31–62) Data are presented as number (percentage) or median (interquartile range, IQR), as appropriate. URS: ureterorenoscopy; JJ stent: double-J ureteral stent. Antibiotic prophylaxis was administered per institutional protocols; agents listed reflect initial perioperative dosing. Table 4 – Infectious Complications Infectious Complications Total (N=350) Fever > 38.0°C – no. (%) 7 (2) Systemic inflammatory response – no. (%) 8 (2) Hospitalization > 3 days – no. (%) 22 (6) Readmission within 30 days for infection – no. (%) 9 (3) Data are presented as number (percentage). Table 5 – Predictors of Postoperative Infectious Complications: Univariable and Multivariable Logistic Regression Analysis Variable Univariable Multivariable Estimate Std. Err. t-value 95% CI p-value Estimate Std. Err. z-value 95% CI p-value OR Age 9.831 3.294 2.294 3.38 to 16.28 0.003 Sex 0.046 0.089 0.512 -0.13 to 0.22 0.609 BMI -0.612 1.189 -0.515 -2.95 to 1.18 0.607 ASA score 0.361 0.122 2.964 0.12 to 0.60 0.003 UT anomalies -0.154 0.047 -3.243 -0.25 to -0.06 <0.001 1.073 0.854 1.257 -0.60 to 2.75 0.209 2.92 Neurogenic bladder -0.238 0.026 -9.127 -0.29 to -0.19 <0.001 4.467 1.159 3.855 2.20 to 6.74 <0.001 87.2 Urolithiasis 0.31 0.129 2.403 0.06 to 0.56 0.017 Positive urine culture 0.573 0.136 4.209 0.31 to 0.84 <0.001 -0.508 0.331 -1.533 -1.16 to 0.14 0.125 0.60 Operative time 3.027 4.35 0.696 -5.53 to 11.58 0.487 Time to JJ stent 27.538 6.906 3.987 13.95 to 41.13 <0.001 -0.016 0.006 -2.827 -0.03 to -0.01 <0.001 0.98 Univariable and multivariable logistic regression analyses were performed to identify predictors of postoperative infectious complications. Estimates reflect the effect size per unit increase in the corresponding variable. OR = odds ratio; CI = confidence interval; ASA = American Society of Anesthesiologists; BMI = body mass index; UT anomalies = urinary tract anomalies. Statistically significant results are shown in bold (p < 0.05). Table 6 – Infection Rates by Dwell Time Groups Infection Count Total Patients Infection Rate (%) 60 days 6 28 21.4 Infection rate represents the proportion of patients in each dwell time group (60 days) who experienced at least one postoperative infectious complication. A Chi-square test was performed to assess differences in infection rates among dwell time groups. The result was statistically significant (χ² = 9.26, p = 0.0098), indicating an increased infection risk associated with longer stent dwell times. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 29 Oct, 2025 Read the published version in World Journal of Urology → Version 1 posted Editorial decision: Revision requested 21 Aug, 2025 Reviews received at journal 18 Aug, 2025 Reviews received at journal 17 Aug, 2025 Reviewers agreed at journal 17 Aug, 2025 Reviews received at journal 17 Aug, 2025 Reviewers agreed at journal 17 Aug, 2025 Reviews received at journal 16 Aug, 2025 Reviewers agreed at journal 08 Aug, 2025 Reviewers agreed at journal 08 Aug, 2025 Reviewers invited by journal 08 Aug, 2025 Editor assigned by journal 31 Jul, 2025 Submission checks completed at journal 31 Jul, 2025 First submitted to journal 28 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7231302","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":499571131,"identity":"e96b06c5-d251-4fc0-b41a-b263321f8da8","order_by":0,"name":"Matteo Ortolini","email":"","orcid":"","institution":"University of Lausanne","correspondingAuthor":false,"prefix":"","firstName":"Matteo","middleName":"","lastName":"Ortolini","suffix":""},{"id":499571133,"identity":"73c491ad-745b-43d9-84bc-86c479168017","order_by":1,"name":"Audrey Masnada","email":"","orcid":"","institution":"University of Lausanne","correspondingAuthor":false,"prefix":"","firstName":"Audrey","middleName":"","lastName":"Masnada","suffix":""},{"id":499571135,"identity":"80c1052b-9a29-427b-b631-79b4bf20b581","order_by":2,"name":"François Crettenand","email":"","orcid":"","institution":"University of Lausanne","correspondingAuthor":false,"prefix":"","firstName":"François","middleName":"","lastName":"Crettenand","suffix":""},{"id":499571136,"identity":"76bbe4a8-6e5e-4487-bd3b-584202623aba","order_by":3,"name":"Kevin Stritt","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYBACCSA+AGYxA/EHCJuNKC0SDMzMjI0ziNUCpZkZm3mI0SLZ3mN4uIChrs68nf/4Y5uaO4kbDjA/e4BPizTPGYPDMxgOS8gcBtqSc+wZUAubuQE+LXISaQmHge6RkAD6pTm34XDizAYeNgm8WuSfgbTUQbRYEqNFWoL5AFALM0QLI1BLPwMBLZI9yUAtBoclZzAzG87sOXbYuJ+ZzQyvFonjB5s/81TU8UvwH3zw4UfNYdk29uZneLVAAEoIMRNWPwpGwSgYBaOAAAAA8ltBBw9NFJQAAAAASUVORK5CYII=","orcid":"","institution":"University of Lausanne","correspondingAuthor":true,"prefix":"","firstName":"Kevin","middleName":"","lastName":"Stritt","suffix":""}],"badges":[],"createdAt":"2025-07-28 08:08:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7231302/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7231302/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00345-025-06042-0","type":"published","date":"2025-10-29T15:58:36+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":89232575,"identity":"9d3ccf42-0a14-45dc-9a9a-d679f700e5fa","added_by":"auto","created_at":"2025-08-17 14:26:35","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":253767,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of urinary culture results among patients with available preoperative cultures (N=303).\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7231302/v1/00ac25b3a3f48937efa36f40.jpeg"},{"id":89232576,"identity":"8a563a5f-e68a-4f8f-9486-b7943d74a6f9","added_by":"auto","created_at":"2025-08-17 14:26:35","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":156641,"visible":true,"origin":"","legend":"\u003cp\u003eInfectious Complication Rate by Dwell Time\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7231302/v1/96e5d941e181d7d39d91cbda.jpeg"},{"id":95040058,"identity":"e8bdcf04-5a71-4b17-9148-7801c93dbb32","added_by":"auto","created_at":"2025-11-03 16:08:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1108134,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7231302/v1/8b229a44-17da-4d18-8b10-1b971e378d8d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prolonged Preoperative Double J Stenting Increases Post-Ureteroscopy Infectious Complications","fulltext":[{"header":"Key Points","content":"\u003cp\u003enephrolithiasis, double J stenting, infectious complications\u003c/p\u003e "},{"header":"Introduction","content":"\u003cp\u003eUrolithiasis is a common and increasingly prevalent condition worldwide. In the United States, the estimated lifetime prevalence of kidney stones is approximately 12% in men and 10% in women [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Beyond being a frequent cause of acute flank pain and emergency department visits, kidney stones are associated with substantial healthcare costs, high recurrence rates, and a significant decline in patient quality of life [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Despite the availability of effective treatment options, long-term management remains challenging due to frequent recurrences.\u003c/p\u003e\u003cp\u003eWhen surgical intervention is warranted, ureterorenoscopy (URS) is a widely adopted and effective modality for stone removal. In many cases\u0026mdash;particularly in the setting of obstructive uropathy or infection\u0026mdash;temporary ureteric double J (JJ) stenting is employed preoperatively to decompress the urinary tract and facilitate access during URS. However, procedural delays due to logistical or institutional constraints can lead to prolonged stent indwelling, which may increase the risk of bacterial colonization, urinary tract infection, and postoperative infectious complications [\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Notably, preoperative JJ stent dwell times exceeding two months have been independently associated with a significantly higher incidence of febrile urinary tract infections after URS [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. These findings emphasize the need to minimize stent duration as part of an optimized strategy to reduce infection-related morbidity in endourological practice.\u003c/p\u003e\u003cp\u003eThe objective of this study was to evaluate whether prolonged preoperative JJ stenting is independently associated with an increased risk of postoperative infectious complications following URS. Identifying this potential risk factor could support the implementation of fast-track surgical pathways aimed at reducing unnecessary stent dwell time and improving clinical outcomes.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eWe conducted a retrospective, single-center study in the Department of Urology at Lausanne University Hospital (CHUV), Switzerland. It included all patients who underwent URS between January 1 and December 31, 2023. Data were extracted from the hospital\u0026rsquo;s secure electronic medical records system (Soarian\u0026reg; Clinicals, Cerner Corporation, Kansas City, MO, USA), which records demographic, clinical, laboratory, radiological, and operative data as part of routine care. No additional data or biological samples were collected for this study.\u003c/p\u003e\u003cp\u003eThe study population consisted of adult patients who underwent URS, regardless of sex or age. Only patients with complete medical records documenting preoperative urine culture results, duration of JJ stenting, intraoperative parameters, and postoperative follow-up were included. Patients with calculi at any location within the ureter or kidney were considered eligible, provided they were legally competent adults at the time of the intervention. Exclusion criteria included deceased individuals, patients who explicitly refused the use of their data for research, and cases lacking diagnostic certainty.\u003c/p\u003e\u003cp\u003eThe primary outcome was defined as infectious complication within 30 days post-URS, corresponding to the occurrence of one or more of the following: fever\u0026thinsp;\u0026gt;\u0026thinsp;38.0\u0026deg;C, systemic inflammatory response, hospitalization\u0026thinsp;\u0026gt;\u0026thinsp;3 days, or readmission for urinary tract infection. We assessed the association between infectious failure and ten predefined clinical variables: age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) score, presence of urinary tract anomalies, neurogenic bladder, indication (urolithiasis vs malignancy), preoperative positive urine culture, operative time, and duration of preoperative JJ stenting (dwell time).\u003c/p\u003e\u003cp\u003eStatistical analysis included descriptive statistics to summarize patient demographics, clinical characteristics, and complication rates. Comparative analyses were conducted using chi-square tests for categorical variables and Student\u0026rsquo;s \u003cem\u003et\u003c/em\u003e-tests or nonparametric equivalents for continuous variables, depending on data distribution. Univariable and multivariable logistic regression models were then conducted to identify independent predictors of infectious complications. All regression analyses were performed using Stata version 17.0 (StataCorp LLC, College Station, TX, USA). A two-sided \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. To assess the impact of stent dwell time on infectious outcomes, patients were stratified into three groups based on dwell duration: \u0026lt;30 days, 31\u0026ndash;60 days, and \u0026gt;\u0026thinsp;60 days. Group comparisons were performed using contingency tables with chi-square tests to evaluate differences in infection rates across categories.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 350 patients who underwent URS during the study period were included in the analysis. The median age was 56 years (IQR 44–69), and 244 patients (70%) were male. The median body mass index (BMI) was 26.8 kg/m² (IQR 23.8–30.5). Regarding ASA classification, 42 patients (12%) were ASA I, 219 (63%) ASA II, 83 (24%) ASA III, and 6 (2%) ASA IV. Urological comorbidities were present in several patients, with 23 individuals (7%) having urinary tract anomalies. These included ureteropelvic junction (UPJ) obstruction in 5 cases (22%), ureteral malformation in 10 cases (43%), cystectomy with urinary diversion in 2 cases (9%), kidney transplant in 3 cases (13%), and other causes in 3 cases (13%). Eight patients (2%) had neurogenic bladder, six of whom (75%) required bladder catheterization. The primary indication for URS was urolithiasis, accounting for 316 patients (90%), of whom 178 (56%) presented with a first episode and 138 (44%) with recurrent stones. Urogenital malignancy was the indication in 34 cases (10%). \u0026nbsp;Baseline demographic characteristics, urological comorbidities, and indications for URS are summarized in Table 1.\u003c/p\u003e\n\u003cp\u003ePreoperative urinary culture was available for 303 patients (87%) (Table 2 and Figure 1). Among these, 190 (63%) had sterile urine, and 53 (17%) showed contamination. The most frequently identified pathogens were Escherichia coli (5%) and Enterococcus faecalis (4%), followed by Pseudomonas aeruginosa (2%). The median time from culture to URS was 7 days (IQR 7–11).\u003c/p\u003e\n\u003cp\u003eRegarding surgical approach, rigid URS was performed in 133 patients (38%), flexible URS in 126 (36%), and a combined rigid and flexible procedure in 91 patients (26%). At the time of URS, a JJ stent was in place in 289 cases (83%), while 61 patients (17%) underwent the procedure without prior stenting.\u003c/p\u003e\n\u003cp\u003eAntibiotic prophylaxis was administered in accordance with institutional guidelines. The most used agents were cefuroxime in 272 patients (78%), followed by amoxicillin/clavulanic acid (7%), ceftriaxone (5%), and other less frequently used antibiotics including sulfamethoxazole/trimethoprim, piperacillin-tazobactam, ciprofloxacin, gentamycin, clindamycin, ertapenem, vancomycin, fluconazole, amikacin, and norfloxacin. The median operative time was 44 minutes (IQR 31–62) (Table 3).\u003c/p\u003e\n\u003cp\u003ePostoperative infectious complications occurred in 29 patients (8.3%) (Table 4). Among these, 7 patients (2%) experienced fever \u0026gt;38.0°C, 8 patients (2%) showed systemic inflammatory response, 22 patients (6%) required hospitalization for more than 3 days, and 9 patients (3%) were readmitted within 30 days due to infection.\u003c/p\u003e\n\u003cp\u003eUnivariable and multivariable logistic regression analyses were performed to identify predictors of infectious complication. In multivariable analysis, prolonged JJ stent dwell time was independently associated with an increased risk of infection (OR 0.984 per day; 95% CI 0.973–0.995; p\u0026lt;0.001), as was the presence of a neurogenic bladder (OR 0.871; 95% CI 2.196–6.739; p\u0026lt;0.001). Other variables, including age, BMI, ASA score, urinary tract anomalies, and positive urine culture, did not remain significant in multivariable analysis. Full regression results are provided in Table 5.\u003c/p\u003e\n\u003cp\u003eTo further evaluate the impact of stent dwell time on infectious complications, patients were stratified into three groups based on stent duration: \u0026lt;30 days, 31–60 days, and \u0026gt;60 days. Infectious complication occurred in 6.0% of patients with dwell time \u0026lt;30 days, 5.5% in the 31–60 day group, and 21.4% in those with stents left in place for more than 60 days. A Chi-square test revealed a statistically significant difference in infection rates between these groups (χ² = 9.26, p = 0.0098), suggesting that prolonged stent indwelling time, particularly beyond 60 days, is associated with a higher risk of postoperative infectious complications. These findings are summarized in Table 6 and Figure 2.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study investigated the relationship between preoperative JJ stent dwell time and the risk of infectious complications following URS. Our results demonstrate that prolonged stent duration is significantly associated with increased postoperative infectious failure, with a particularly notable rise in infection risk beyond 60 days of indwelling time.\u003c/p\u003e\n\u003cp\u003eThe findings align with previous reports suggesting that indwelling stents act as a nidus for bacterial colonization, increasing the risk of urinary tract infections and sepsis following endourological procedures. In our cohort, patients with stent dwell times exceeding two months experienced a more than threefold higher rate of infectious complications compared to those with shorter durations. This reinforces earlier studies identifying prolonged stenting as a modifiable risk factor for infection, particularly in high-risk populations\u0026nbsp;[7\u0026ndash;10].\u003c/p\u003e\n\u003cp\u003eOur multivariable analysis further identified neurogenic bladder as an independent predictor of infectious failure. This is consistent with existing literature, where impaired bladder emptying, detrusor dysfunction, and chronic catheterization are well-established contributors to urinary tract infections and postoperative sepsis\u0026nbsp;[11\u0026ndash;13]. Neurogenic bladder alters normal voiding dynamics and often necessitates intermittent or indwelling catheterization, both of which facilitate bacterial colonization and biofilm formation\u0026nbsp;[12]. Although other factors such as positive preoperative urine cultures and higher ASA scores showed statistical significance in univariable analyses, their effects were attenuated in multivariable models, highlighting the predominant influence of stent dwell time and neurogenic dysfunction in driving postoperative infectious outcomes.\u003c/p\u003e\n\u003cp\u003eImportantly, our subgroup analysis showed a statistically significant difference in infection rates across dwell time categories (\u0026lt;30 days, 31\u0026ndash;60 days, and \u0026gt;60 days), suggesting that a threshold effect may exist. This observation is supported by prior studies demonstrating that JJ stent indwelling beyond 60 days is associated with higher rates of urinary tract infections, febrile episodes, and complications during URS [14\u0026ndash;16]. This stratification may serve as a practical clinical tool to guide surgical planning. Reducing stent dwell times where feasible\u0026mdash;ideally limiting preoperative stenting to under two months\u0026mdash;may reduce infection-related morbidity and healthcare burden\u0026nbsp;[14,17].\u003c/p\u003e\n\u003cp\u003eThese findings have direct implications for clinical practice. First, they emphasize the need for streamlined scheduling and prioritization of definitive stone treatment in patients with indwelling JJ stents. Second, they support the development of institutional \u0026ldquo;fast-track\u0026rdquo; URS protocols aimed at minimizing unnecessary stent dwell time. Finally, they underscore the importance of careful monitoring and preoperative optimization, particularly in patients with complex urinary tract anatomy or neurogenic bladder.\u003c/p\u003e\n\u003cp\u003eThis study has several important limitations. First, its retrospective, single-center design introduces potential selection, information, and observer biases that may have influenced the findings. Although clinical, surgical, and microbiological data were extracted from a well-maintained electronic health record system, retrospective analyses inherently lack control over data completeness and uniformity. Second, some relevant clinical parameters\u0026mdash;such as stone burden, stone composition, and precise microbial resistance profiles\u0026mdash;were not included in the multivariable analysis. These factors have been previously shown to influence infectious outcomes following URS and could confound the associations observed in this study [18,19]. Third, although most patients received cefuroxime as per institutional prophylactic guidelines, the antibiotic regimen was not uniformly standardized across all cases. This variability in prophylaxis may have influenced postoperative infection rates, especially in patients harboring resistant organisms. Standardizing antibiotic protocols and incorporating resistance data could enhance future analyses [20]. Finaly, our study population exhibited a sex imbalance, with men comprising 70% of the cohort. This overrepresentation reflects the known epidemiological pattern of higher urolithiasis prevalence in men [21], but it may limit the external validity of our findings, particularly for female patients who may present different risk profiles and stent-related symptomatology [17].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eProlonged indwelling time of JJ ureteral stents is an independent and clinically significant risk factor for postoperative infectious complications following URS. These findings underscore the importance of minimizing stent dwell time through expedited surgical scheduling and support the development of structured, fast-track care pathways. Implementing such protocols may contribute to reducing infection-related morbidity, improving patient outcomes, and optimizing resource utilization in endourological practice.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the Department of Urology at Lausanne University Hospital (CHUV) for their support in facilitating this study. We are particularly grateful to the clinical and administrative staff for their assistance in data collection and patient follow-up. No external funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor’s contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConceptualization:\u003c/strong\u003e Kevin Stritt, Matteo Ortolini.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData curation:\u003c/strong\u003e Kevin Stritt.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFormal analysis:\u003c/strong\u003e Kevin Stritt, Matteo Ortolini.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding acquisition:\u003c/strong\u003e Kevin Stritt.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInvestigation:\u003c/strong\u003e Kevin Stritt, Matteo Ortolini.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology:\u003c/strong\u003e Kevin Stritt, Matteo Ortolini.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProject administration:\u003c/strong\u003e Kevin Stritt.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResources:\u003c/strong\u003e Kevin Stritt.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSoftware:\u003c/strong\u003e Kevin Stritt.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupervision:\u003c/strong\u003e Kevin Stritt, Matteo Ortolini.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eValidation:\u003c/strong\u003e Kevin Stritt.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVisualization:\u003c/strong\u003e Kevin Stritt.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWriting–original draft:\u003c/strong\u003e Kevin Stritt.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWriting–review \u0026amp; editing:\u003c/strong\u003e Matteo Ortolini, François Crettenand, Audrey Masnada.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor disclosure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest related to this work. No competing financial interests exist. No external funding was received for the conduct of this study or the preparation of this manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRomero V, Akpinar H, Assimos DG. Kidney stones: a global picture of prevalence, incidence, and associated risk factors. \u003cem\u003eRev Urol\u003c/em\u003e. 2010;12(2-3):e86\u0026ndash;96.\u003c/li\u003e\n\u003cli\u003eScales CD Jr, Smith AC, Hanley JM, Saigal CS; Urologic Diseases in America Project. Prevalence of kidney stones in the United States. \u003cem\u003eEur Urol\u003c/em\u003e. 2012;62(1):160\u0026ndash;5.\u003c/li\u003e\n\u003cli\u003eAbufaraj M, Xu T, Cao C, Siyam A, Waldhoer T, Mari A, et al. Prevalence and trends in kidney stone among adults in the USA: analyses of National Health and Nutrition Examination Survey 2007\u0026ndash;2018 data. \u003cem\u003eEur Urol Focus\u003c/em\u003e. 2021;7(6):1468\u0026ndash;75.\u003c/li\u003e\n\u003cli\u003eFerraro PM, Curhan GC, D\u0026apos;Addessi A, Gambaro G. Risk of recurrence of idiopathic calcium kidney stones: analysis of data from the literature. \u003cem\u003eJ Nephrol\u003c/em\u003e. 2017;30(2):227\u0026ndash;33.\u003c/li\u003e\n\u003cli\u003eNew F, Somani BK. A complete world literature review of quality of life (QOL) in patients with kidney stone disease (KSD). \u003cem\u003eCurr Urol Rep\u003c/em\u003e. 2016;17(12):88.\u003c/li\u003e\n\u003cli\u003eSaigal CS, Joyce G, Timilsina AR; Urologic Diseases in America Project. Direct and indirect costs of nephrolithiasis in an employed population: opportunity for disease management? \u003cem\u003eKidney Int\u003c/em\u003e. 2005;68(4):1808\u0026ndash;14.\u003c/li\u003e\n\u003cli\u003eGeraghty RM, Pietropaolo A, Skolarikos A, et al. Post-ureteroscopy infections are linked to pre-operative stent dwell time over two months: outcomes of three European Endourology centres. J Clin Med. 2022;11(1):147.\u003c/li\u003e\n\u003cli\u003eNevo A, Mano R, Baniel J, Lifshitz D. Ureteric stent dwelling time: a risk factor for post-ureteroscopy sepsis. BJU Int. 2017;119(1):117\u0026ndash;22.\u003c/li\u003e\n\u003cli\u003e\u0026Uuml;lker V, Yılmaz N, Ağuş N, et al. Bacterial colonization of ureteral double-J stents in patients with negative urine culture. J Urol Surg. 2019;6(2):125\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eShi YF, Ju WL, Zhu YP, et al. The impact of ureteral stent indwelling time on the treatment of acute infection caused by ureteral calculi. Urolithiasis. 2017;45(6):579\u0026ndash;83.\u003c/li\u003e\n\u003cli\u003eWeld KJ, Dmochowski RR. Effect of bladder management on urological complications in spinal cord injured patients. J Urol. 2000;163(3):768\u0026ndash;772.\u003c/li\u003e\n\u003cli\u003eGroah SL, Weitzenkamp D, Lammertse DP, et al. Excess risk of bladder cancer in spinal cord injury: Evidence for an association between indwelling catheter use and bladder cancer. Arch Phys Med Rehabil. 2002;83(3):346\u0026ndash;351.\u003c/li\u003e\n\u003cli\u003eNicolle LE. Catheter-related urinary tract infection. Drugs Aging. 2005;22(8):627\u0026ndash;639.\u003c/li\u003e\n\u003cli\u003eNevo A, Mano R, Baniel J, et al. The impact of ureteral stent dwelling time on infectious complications following ureteroscopy: a multi-institutional study. J Endourol. 2020;34(4):427\u0026ndash;431.\u003c/li\u003e\n\u003cli\u003eKawahara T, Ito H, Terao H, et al. Ureteral stent encrustation, incrustation, and coloring: morbidity related to indwelling times. J Endourol. 2012;26(2):178\u0026ndash;182.\u003c/li\u003e\n\u003cli\u003eAboumarzouk OM, Kata SG. Ureteroscopic management of ureteric stones: a meta-analysis of literature. Arab J Urol. 2016;14(1):29\u0026ndash;38.\u003c/li\u003e\n\u003cli\u003eT\u0026uuml;rk C, Neisius A, Petř\u0026iacute;k A, et al. EAU Guidelines on Urolithiasis. Eur Urol. 2022. [Available at: https://uroweb.org/guidelines/urolithiasis]\u003c/li\u003e\n\u003cli\u003eTaylor E, Miller J, Chi T, Stoller ML. Complications associated with ureteral stents. Int Urol Nephrol. 2012;44(3):905\u0026ndash;913.\u003c/li\u003e\n\u003cli\u003eBerardinelli F, Proietti S, Cindolo L, et al. Infective complications after retrograde intrarenal surgery: a new standardized classification system. Int Urol Nephrol. 2016;48(11):1757\u0026ndash;1762.\u003c/li\u003e\n\u003cli\u003eHooton TM, Gupta K. Antimicrobial prophylaxis: optimizing strategies for prevention of urinary tract infections. Clin Infect Dis. 2019;68(11):1952\u0026ndash;1959.\u003c/li\u003e\n\u003cli\u003eScales CD Jr, Smith AC, Hanley JM, Saigal CS. Prevalence of kidney stones in the United States. Eur Urol. 2012;62(1):160\u0026ndash;165.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 \u0026ndash; Baseline Demographic, Urological Comorbidities, and Indications for URS\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eCharacteristic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eTotal (N=350)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eMedian age \u0026ndash; yr (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e56 (44\u0026ndash;69)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eSex, male \u0026ndash; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e244 (70)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eSex, female \u0026ndash; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e106 (30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eMedian BMI \u0026ndash; kg/m\u0026sup2; (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e26.8 (23.8\u0026ndash;30.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eASA score \u0026ndash; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e42 (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e219 (63)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e83 (24)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e6 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eUrological comorbidities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eUrinary tract anomalies \u0026ndash; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e23 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; UPJ obstruction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e5 (22)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Ureteral malformation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e10 (43)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Cystectomy with diversion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e2 (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Kidney transplant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e3 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e3 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eNeurogenic bladder \u0026ndash; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e8 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; With bladder catheterization \u0026ndash; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e6 (75)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eIndications for URS \u0026ndash; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Urolithiasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e316 (90)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; First episode\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e178 (56)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Recurrence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e138 (44)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Urogenital cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e34 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are presented as number (percentage) or median (interquartile range, IQR), as appropriate.\u003cbr\u003e\u0026nbsp;BMI: body mass index; ASA: American Society of Anesthesiologists score; UPJ: ureteropelvic junction; URS: ureterorenoscopy.\u003c/p\u003e\n\u003ch3\u003eTable 2 \u0026ndash; Urinary Culture Results\u003c/h3\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eUrinary Culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eTotal (N=350)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003ePathogen identified:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Sterile culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e190 (63)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Contamination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e53 (17)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Escherichia coli\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e14 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Enterococcus faecalis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e12 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Pseudomonas aeruginosa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e5 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Klebsiella pneumoniae group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e4 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Candida albicans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e3 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Citrobacter koseri\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e3 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Staphylococcus aureus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e2 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Serratia marcescens group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e1 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Proteus mirabilis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e1 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Polymicrobial culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e15 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eMedian time from culture to URS \u0026ndash; days (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e7 (7\u0026ndash;11)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are presented as number (percentage) or median (interquartile range, IQR), as appropriate.\u003cbr\u003e\u0026nbsp;URS: ureterorenoscopy. Contamination refers to mixed flora or non-uropathogenic isolates not meeting criteria for true infection. \u0026quot;Polymicrobial culture\u0026quot; includes samples with two or more distinct uropathogens.\u003c/p\u003e\n\u003cp\u003eTable 3 \u0026ndash; Interventions\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eIntervention Details\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eTotal (N=350)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eURS Approach \u0026ndash; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Rigid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e133 (38)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Flexible\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e126 (36)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Rigid + Flexible\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e91 (26)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eJJ Stent in Situ \u0026ndash; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e289 (83)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e61 (17)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eAntibiotic Prophylaxis \u0026ndash; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Cefuroxime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e272 (78)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Amoxicillin/Clavulanic Acid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e26 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Ceftriaxone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e16 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Sulfamethoxazole/Trimethoprim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e7 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Piperacillin-tazobactam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e7 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Ciprofloxacin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e6 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Gentamycin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e5 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Clindamycin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e3 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Ertapenem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e2 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Vancomycin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e2 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Fluconazole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e2 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Amikacin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e1 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp; Norfloxacin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e1 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eMedian Operative Time \u0026ndash; min (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e44 (31\u0026ndash;62)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are presented as number (percentage) or median (interquartile range, IQR), as appropriate. URS: ureterorenoscopy; JJ stent: double-J ureteral stent. Antibiotic prophylaxis was administered per institutional protocols; agents listed reflect initial perioperative dosing.\u003c/p\u003e\n\u003ch3\u003eTable 4 \u0026ndash; Infectious Complications\u003c/h3\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eInfectious Complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eTotal (N=350)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eFever \u0026gt; 38.0\u0026deg;C \u0026ndash; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e7 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eSystemic inflammatory response \u0026ndash; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e8 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eHospitalization \u0026gt; 3 days \u0026ndash; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e22 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eReadmission within 30 days for infection \u0026ndash; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e9 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are presented as number (percentage).\u003c/p\u003e\n\u003cp\u003eTable 5 \u0026ndash; Predictors of Postoperative Infectious Complications: Univariable and Multivariable Logistic Regression Analysis\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.27152%;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78146%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.61589%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.60265%;\"\u003e\n \u003cp\u003eUnivariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78146%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.28477%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.10596%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.10596%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.596%;\"\u003e\n \u003cp\u003eMultivariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.61589%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.11258%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.12583%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.27152%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78146%;\"\u003e\n \u003cp\u003eEstimate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.61589%;\"\u003e\n \u003cp\u003eStd. Err.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.60265%;\"\u003e\n \u003cp\u003et-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78146%;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.28477%;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.10596%;\"\u003e\n \u003cp\u003eEstimate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.10596%;\"\u003e\n \u003cp\u003eStd. Err.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.596%;\"\u003e\n \u003cp\u003ez-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.61589%;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.11258%;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.12583%;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.27152%;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78146%;\"\u003e\n \u003cp\u003e9.831\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.61589%;\"\u003e\n \u003cp\u003e3.294\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.60265%;\"\u003e\n \u003cp\u003e2.294\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78146%;\"\u003e\n \u003cp\u003e3.38 to 16.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.28477%;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.10596%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.10596%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.596%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.61589%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.11258%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.12583%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.27152%;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78146%;\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.61589%;\"\u003e\n \u003cp\u003e0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.60265%;\"\u003e\n \u003cp\u003e0.512\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78146%;\"\u003e\n \u003cp\u003e-0.13 to 0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.28477%;\"\u003e\n \u003cp\u003e0.609\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.10596%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.10596%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.596%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.61589%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.11258%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.12583%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.27152%;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78146%;\"\u003e\n \u003cp\u003e-0.612\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.61589%;\"\u003e\n \u003cp\u003e1.189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.60265%;\"\u003e\n \u003cp\u003e-0.515\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78146%;\"\u003e\n \u003cp\u003e-2.95 to 1.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.28477%;\"\u003e\n \u003cp\u003e0.607\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.10596%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.10596%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.596%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.61589%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.11258%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.12583%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.27152%;\"\u003e\n \u003cp\u003eASA score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78146%;\"\u003e\n \u003cp\u003e0.361\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.61589%;\"\u003e\n \u003cp\u003e0.122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.60265%;\"\u003e\n \u003cp\u003e2.964\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78146%;\"\u003e\n \u003cp\u003e0.12 to 0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.28477%;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.10596%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.10596%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.596%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.61589%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.11258%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.12583%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.27152%;\"\u003e\n \u003cp\u003eUT anomalies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78146%;\"\u003e\n \u003cp\u003e-0.154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.61589%;\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.60265%;\"\u003e\n \u003cp\u003e-3.243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78146%;\"\u003e\n \u003cp\u003e-0.25 to -0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.28477%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.10596%;\"\u003e\n \u003cp\u003e1.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.10596%;\"\u003e\n \u003cp\u003e0.854\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.596%;\"\u003e\n \u003cp\u003e1.257\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.61589%;\"\u003e\n \u003cp\u003e-0.60 to 2.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.11258%;\"\u003e\n \u003cp\u003e0.209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.12583%;\"\u003e\n \u003cp\u003e2.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.27152%;\"\u003e\n \u003cp\u003eNeurogenic bladder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78146%;\"\u003e\n \u003cp\u003e-0.238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.61589%;\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.60265%;\"\u003e\n \u003cp\u003e-9.127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78146%;\"\u003e\n \u003cp\u003e-0.29 to -0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.28477%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.10596%;\"\u003e\n \u003cp\u003e4.467\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.10596%;\"\u003e\n \u003cp\u003e1.159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.596%;\"\u003e\n \u003cp\u003e3.855\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.61589%;\"\u003e\n \u003cp\u003e2.20 to 6.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.11258%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.12583%;\"\u003e\n \u003cp\u003e87.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.27152%;\"\u003e\n \u003cp\u003eUrolithiasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78146%;\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.61589%;\"\u003e\n \u003cp\u003e0.129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.60265%;\"\u003e\n \u003cp\u003e2.403\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78146%;\"\u003e\n \u003cp\u003e0.06 to 0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.28477%;\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.10596%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.10596%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.596%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.61589%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.11258%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.12583%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.27152%;\"\u003e\n \u003cp\u003ePositive urine culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78146%;\"\u003e\n \u003cp\u003e0.573\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.61589%;\"\u003e\n \u003cp\u003e0.136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.60265%;\"\u003e\n \u003cp\u003e4.209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78146%;\"\u003e\n \u003cp\u003e0.31 to 0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.28477%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.10596%;\"\u003e\n \u003cp\u003e-0.508\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.10596%;\"\u003e\n \u003cp\u003e0.331\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.596%;\"\u003e\n \u003cp\u003e-1.533\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.61589%;\"\u003e\n \u003cp\u003e-1.16 to 0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.11258%;\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.12583%;\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.27152%;\"\u003e\n \u003cp\u003eOperative time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78146%;\"\u003e\n \u003cp\u003e3.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.61589%;\"\u003e\n \u003cp\u003e4.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.60265%;\"\u003e\n \u003cp\u003e0.696\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78146%;\"\u003e\n \u003cp\u003e-5.53 to 11.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.28477%;\"\u003e\n \u003cp\u003e0.487\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.10596%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.10596%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.596%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.61589%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.11258%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.12583%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 9.27152%;\"\u003e\n \u003cp\u003eTime to JJ stent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78146%;\"\u003e\n \u003cp\u003e27.538\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.61589%;\"\u003e\n \u003cp\u003e6.906\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.60265%;\"\u003e\n \u003cp\u003e3.987\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.78146%;\"\u003e\n \u003cp\u003e13.95 to 41.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.28477%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.10596%;\"\u003e\n \u003cp\u003e-0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.10596%;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.596%;\"\u003e\n \u003cp\u003e-2.827\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.61589%;\"\u003e\n \u003cp\u003e-0.03 to -0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.11258%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.12583%;\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eUnivariable and multivariable logistic regression analyses were performed to identify predictors of postoperative infectious complications. Estimates reflect the effect size per unit increase in the corresponding variable. OR = odds ratio; CI = confidence interval; ASA = American Society of Anesthesiologists; BMI = body mass index; UT anomalies = urinary tract anomalies. Statistically significant results are shown in bold (p \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003eTable 6 \u0026ndash; Infection Rates by Dwell Time\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eGroups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eInfection Count\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eTotal Patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eInfection Rate (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026lt;30 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e31\u0026ndash;60 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026gt;60 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e21.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eInfection rate represents the proportion of patients in each dwell time group (\u0026lt;30 days, 31\u0026ndash;60 days, \u0026gt;60 days) who experienced at least one postoperative infectious complication. A Chi-square test was performed to assess differences in infection rates among dwell time groups. The result was statistically significant (\u0026chi;\u0026sup2; = 9.26, p = 0.0098), indicating an increased infection risk associated with longer stent dwell times.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjur","sideBox":"Learn more about [World Journal of Urology](https://link.springer.com/journal/345)","snPcode":"345","submissionUrl":"https://submission.nature.com/new-submission/345/3","title":"World Journal of Urology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7231302/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7231302/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe 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 \u0026gt;38.0°C, systemic inflammatory response, hospitalization \u0026gt;3 days, or readmission for urinary infection. Ten predefined clinical variables were analyzed using univariable and multivariable logistic regression to identify independent predictors of infectious failure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost 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\u0026lt;0.001). Multivariable analysis identified prolonged stent dwell time (OR 0.984 per day; 95% CI 0.973–0.995; p\u0026lt;0.001) and neurogenic bladder (OR 0.871; 95% CI 2.196–6.739; p\u0026lt;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\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eProlonged 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.\u003c/p\u003e","manuscriptTitle":"Prolonged Preoperative Double J Stenting Increases Post-Ureteroscopy Infectious Complications","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-17 14:18:30","doi":"10.21203/rs.3.rs-7231302/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-21T10:30:14+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-18T15:39:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-17T16:07:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"83873047251036765708258738288572480124","date":"2025-08-17T15:13:50+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-17T12:28:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"271238438551727619887404094640140212249","date":"2025-08-17T08:28:42+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-17T03:11:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"301554805918630435432898103826899613037","date":"2025-08-09T00:09:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"86066820234746292647465170110825524409","date":"2025-08-08T16:27:09+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-08T16:07:12+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-31T17:27:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-31T14:56:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"World Journal of Urology","date":"2025-07-28T08:02:14+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjur","sideBox":"Learn more about [World Journal of Urology](https://link.springer.com/journal/345)","snPcode":"345","submissionUrl":"https://submission.nature.com/new-submission/345/3","title":"World Journal of Urology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"0a34e713-f384-40ec-bf58-5f9ae0ebc457","owner":[],"postedDate":"August 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-03T16:03:29+00:00","versionOfRecord":{"articleIdentity":"rs-7231302","link":"https://doi.org/10.1007/s00345-025-06042-0","journal":{"identity":"world-journal-of-urology","isVorOnly":false,"title":"World Journal of Urology"},"publishedOn":"2025-10-29 15:58:36","publishedOnDateReadable":"October 29th, 2025"},"versionCreatedAt":"2025-08-17 14:18:30","video":"","vorDoi":"10.1007/s00345-025-06042-0","vorDoiUrl":"https://doi.org/10.1007/s00345-025-06042-0","workflowStages":[]},"version":"v1","identity":"rs-7231302","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7231302","identity":"rs-7231302","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}