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Prophylactic antibiotics are associated with lower risk of UTI in children with tethered ureteral stents after ureteroscopy for nephrolithiasis.
William N. Harris, MD, Juliana Arenas, MD, Alexandra M.C. Carolan, MD, Shane F. Batie, MD, Bruce J. Schlomer, MD, Micah A. Jacobs, MD, Craig A. Peters, MD, Irina Stanasel, MD.
University of Texas Southwestern Medical Center, Children's Health, Dallas, TX, USA.
BackgroundThe incidence of nephrolithiasis in children has increased in recent decades. Ureteral stents are frequently placed after ureteroscopy. In adult urology, stent removal can be done in the office without sedation. Unfortunately, stent removal in children requires another anesthetic. Therefore, the use of stents on tethers in the pediatric population is appealing to minimize the need for a second anesthetic. There is concern, however, that tethers can lead to an increase in urinary tract infections (UTI). The goal of this study was to evaluate the rates of UTI in patients who had a tethered stent after ureteroscopy for nephrolithiasis, and either received antibiotic prophylaxis or received no antibiotic prophylaxis. We hypothesized that antibiotics prophylaxis is associated with a lower UTI rate and lower UTI related readmissions.
MethodsCPT codes were used to identify patients who underwent ureteroscopy for stone disease between August 2022-August 2025. Patients who had ureteroscopy but did not have a stent on a tether were excluded. UTIs within 30 days of the procedure and readmissions due to UTI within 30 days of procedure were recorded. Fischer's exact 2-tailed test was used to compare UTI rates between the two groups, antibiotic prophylaxis and no antibiotic prophylaxis. Firth‑penalized Cox proportional hazards regression was used to estimate hazard ratios because no UTIs occurred in the prophylaxis group.
Results134 ureteroscopy patients were identified, 62 of whom had a stent on a tether and were included in the analysis. There was a total of 67 ureteroscopy procedures. 4 patients had two ureteroscopy procedures and 1 patient had 3 procedures. Antibiotic prophylaxis was given to patients after 40 ureteroscopy procedures, while antibiotic prophylaxis was not prescribed after 27 procedures. Mean stent dwell time for the prophylaxis group was 4 days, compared to 4.5 days for no prophylaxis (p=0.1). There were no UTIs following the 40 ureteroscopy procedures in which patients had a tethered stent and were on antibiotic prophylaxis. There were 4 (15%) UTIs following the 27 procedures in which patients did not receive prophylactic antibiotics. The 4 UTIs occurred in 4 individual patients. Of these 4 patients, 3 were admitted for a febrile UTI (11% readmission rate) while one was treated as an outpatient for a non-febrile UTI. Prophylaxis was significantly associated with lower rate of UTI (p=0.023). Prophylactic antibiotics were associated with an approximately 90% lower hazard of urinary tract infection while ureteral stents were in place (hazard ratio 0.105, 95% confidence interval 0.0008-1.09).
ConclusionsProphylactic antibiotics while a tethered stent was in place was associated with lower risk of UTI (0% vs 15%, p=0.023). A short course of antibiotics while a tethered stent is indwelling may reduce UTIs and readmissions for UTIs after ureteroscopy for kidney and ureteral stones.
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