Urosepsis resulting from obstructive acute pyelonephritis (APN) linked to ureteral stones poses significant management challenges, with no universally accepted protocols for antibiotics, drainage, or surgical intervention timing. To address this gap, the team analyzed data from 107 patients treated between 2013 and 2019 who underwent PCN followed by URSL. Patient demographics, comorbidities, laboratory findings, microbiological profiles, and stone characteristics were reviewed to identify key predictors of post-URSL complications.
The following were the study’s key findings:
- 32% of patients developed fever following ureteroscopic lithotripsy (URSL).
- Afebrile patients had received antibiotics for a longer duration before surgery (7.1 vs. 5.7 days).
- Those without fever experienced shorter postoperative hospital stays (3.1 vs. 5.3 days).
- The duration of antibiotic therapy and the interval between percutaneous nephrostomy (PCN) placement and URSL were significant predictors of post-surgical fever risk.
- Administering antibiotics for more than seven days before URSL was linked to a lower incidence of postoperative fever.
- Diabetes mellitus was identified as an independent risk factor for post-URSL fever in patients receiving prolonged antibiotic therapy, increasing the risk ninefold (odds ratio = 9.07).
- Emergent PCN drainage facilitated earlier URSL and contributed to shorter hospital stays.
- Escherichia coli was the most commonly isolated pathogen, consistent with patterns in urinary tract infections.
The findings emphasize the need for careful preoperative planning, particularly in diabetic patients, and highlight the benefit of timely PCN combined with an adequate duration of antibiotics to minimize complications and optimize recovery.
While the results provide valuable real-world evidence for managing urosepsis due to upper ureteral stones, the authors noted several limitations. The retrospective, single-center nature of the study may have introduced selection bias, and factors such as stone composition, operative time, and intraoperative complications were not fully assessed. Additionally, the influence of bacterial strain variations on postoperative systemic inflammatory response syndrome (SIRS) was not evaluated. Advances such as intrarenal pressure monitoring and irrigation pressure control were also not incorporated into the study design.
The authors emphasized the need for larger, prospective, randomized trials to validate these findings and establish standardized protocols. Nonetheless, the study offers important insights, suggesting that emergent PCN and antibiotic courses longer than seven days can significantly improve outcomes in patients with urosepsis complicated by upper ureteral stones, while also identifying diabetes mellitus as a key risk factor for postoperative fever.
Reference:
Hsu, JT., Lin, CM., Hung, SF. et al. Optimizing antibiotic duration and percutaneous nephrostomy timing in urosepsis complicated by upper ureteral stones: a retrospective study. BMC Urol 25, 182 (2025). https://doi.org/10.1186/s12894-025-01868-7
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