Safety of Omitting Preoperative Antibiotic Prophylaxis in Patients Undergoing Transurethral Ureterolithotripsy

Background: Transurethral ureterolithotripsy (TUL) is a common and highly efficient procedure for treating ureteral stones. The need for preoperative antibiotic prophylaxis to prevent post-TUL infections remains controversial. Objectives: This study aimed to investigate whether the removal of preoperative antibiotic prophylaxis affects the rate of postoperative complications in patients undergoing TUL. Methods: A total of 62 patients (aged 15-65 years) undergoing TUL between November 2021 and March 2022 were included in this controlled clinical trial. Patients were divided into two groups by the available gradual and sequential sampling methods: 33 had positive preoperative urine culture (UC), and 29 had negative preoperative UC. None of the patients in the two groups received preoperative antibiotic prophylaxis. Perioperative and postoperative outcomes, such as the operative time, stone-free rate, postoperative analgesic use, fever, urinary tract infection (UTI), and hospital stay, were reviewed in both groups. Results: Patients with positive UC were significantly older than those with negative UC (P=0.018), and had a higher BMI (P=0.016). No significant differences were observed between the two groups in most perioperative variables or postoperative outcomes (P>0.05). In addition, patients in the positive UC group had significantly more underlying diseases than the other group (P=0.022). Postoperative symptomatic UTI was found in neither of the two groups. Fever was reported in 3 (9.1%) and 1 (3.4%) patients in the positive and negative UC groups, respectively, with no statistically significant differences between the two groups (P=0.616). In the matched logistic regression model, the effect of preoperative UC on postoperative fever was not significant (P=0.40). Conclusion: The results of our study showed that prophylactic antibiotics can be eliminated at the discretion of the surgeon in patients without symptomatic positive UC.