Abstract: PD64-02
Sources of Funding: NONE

Introduction

Ureteroscopy is commonly used to treat kidney and ureteral stones. While generally considered safe and effective, there is a small but growing body of evidence suggesting that patients with neurogenic bladder are at an increased risk of infectious complications following ureteroscopy. We sought to characterize the rate of febrile urinary tract infections (UTI) after ureteroscopy in patients with neurogenic bladder compared to those with physiologically normal bladders. We also investigated whether it is the neurogenic bladder itself or the neurogenic bladder in the context of bacterial colonization due to catheterization that might be the root cause.

Methods

We retrospectively reviewed a cohort of patients from a single academically affiliated hospital system who underwent ureteroscopy between June 2013 and May 2016. Information regarding the patient’s neurogenic bladder status, preoperative culture results, bladder management method and presence of upper tract decompression (ureteral stent or nephrostomy) was collected. Postoperative febrile UTI was defined as a hospital admission within 1 week of surgery due to fever not attributable to another source.

Results

During the study period we identified 467 ureteroscopies, of which 44 (9.5%) were performed on patients with a neurogenic bladder. Postoperative febrile UTI rates were higher in patients with neurogenic bladder as compared to control patients (9% vs 1.4%, respectively, p= 0.01). The risk of febrile UTI after ureteroscopy did not appear to be equally distributed among those with neurogenic bladder. Postoperative febrile UTIs were not seen in neurogenic bladder patients who were catheter independent (0/12). Interestingly, the presence of a nephrostomy tube in patients with physiologically normal bladders increased the risk of postoperative febrile UTI to levels comparable to neurogenic bladder patients who were catheter dependent (10.5% vs 12.5%, respectively).

Conclusions

While the presence of a neurogenic bladder may increase the risk of infectious complications after ureteroscopy, the reliance on intermittent or indwelling catheters for bladder management appears to be a more important factor. Interestingly, a similar risk of postoperative febrile UTI also appears to be present in non-neurogenic patients with nephrostomy tubes. These data suggest that bacterial colonization, which is prevalent in patients with neurogenic bladder, may be a significant underlying risk factor for febrile UTI after ureteroscopy.

Funding

NONE