Febrile UTI (fUTI) is common in patients with preoperative obstructive pyelonephritis. This study understands the risk of developing fUTI after obstructive pyelonephritis treatment (incl. URSL optimal timing).

The study covered 1361 patients who had URSL between 2011 and 2017. 239 patients had a history of obstructive pyelonephritis before URSL. The researchers studied the individual backgrounds with and without fUTI post URSL to compare the risk factors. The primary factors added are age, BMI, gender, presence of a pre-operative ureteral stent, comorbidity, stone position, stone size, HU value, history of sepsis, stone laterality, the period between antipyresis and URSL, operation time, presence of access sheath, and ureteral stenting period. The study also included renal pelvic urinary culture species and stone components.

After URSL, fUTI developed in 32 patients out of a total of 239. 11 of 32 had sepsis. The analysis showed that the presence of sepsis, stone maximum HU, the period between antipyresis and URSL, operation time, pre-URSL ureteral stent, and stone position were the risk elements of fUTI. Urinary culture or stone components did not play a part in this occurrence. Other risk factors are operation time more than 75 minutes, ureteral stent placement more than 21 days, and renal stone position.

It is possible to avoid fUTI after URSL by reducing ureteral stent placement by less than 21 days and keeping operation time less than or equal to 75 minutes.

Ref: https://bmcurol.biomedcentral.com/articles/10.1186/s12894-020-00754-8