Enhanced vs Extended Preoperative Antibiotic Prophylaxis in High-Risk RIRS Patients

Overview

This randomized controlled study compared 2-day (Enhanced) versus 7-day (Extended) preoperative antibiotic prophylaxis (AP) in high-risk patients undergoing retrograde intrarenal surgery (RIRS). The primary outcome was postoperative infectious complications, with secondary outcomes including positive urine cultures, hospital stay, stone-free rates, and readmissions.

Background

Retrograde intrarenal surgery (RIRS) is an established treatment for upper urinary tract stones but carries a risk of postoperative infectious complications ranging from urinary tract infections to severe urosepsis. High-risk factors include asymptomatic bacteriuria, prolonged ureteral stenting, and diabetes mellitus. Optimal duration of preoperative antibiotic prophylaxis remains unclear, with a need to balance infection prevention against antibiotic resistance and adverse events. This study aimed to clarify the efficacy of two AP durations in high-risk patients.

Data Highlights

Key Findings

• RIRS is widely used for renal stones ≤20 mm with recognized infectious risks postoperatively.
• High-risk patients were defined by presence of asymptomatic bacteriuria, indwelling ureteral stent >4 weeks, or diabetes mellitus.
• Two antibiotic prophylaxis regimens were compared: 2-day (Enhanced) versus 7-day (Extended) preoperative courses.
• Antibiotic choice was tailored based on urine culture results or institutional protocols for negative cultures.
• Primary outcome was incidence of postoperative infectious complications graded by EAU Infection Severity Scale.
• Secondary outcomes included postoperative urine culture positivity, hospital stay duration, stone-free rates, and readmission rates.

Clinical Implications

Clinicians should consider patient-specific infection risk factors when planning preoperative antibiotic prophylaxis for RIRS. Tailoring antibiotic duration may optimize infection prevention while minimizing antibiotic exposure and resistance. This study provides evidence to guide duration of prophylaxis in high-risk patients, although detailed outcome data are needed to inform definitive recommendations.

Conclusion

This randomized trial addresses an important clinical question regarding optimal antibiotic prophylaxis duration in high-risk RIRS patients. The findings will help balance infection prevention with antimicrobial stewardship in endourological practice.

References

1. 1 -- RIRS as a safe and effective management for upper urinary tract calculi
2. 2 -- Infectious complications after RIRS and importance of prophylaxis
3. 3 -- Risk factors for post-RIRS infectious complications
4. 4 -- Intraoperative factors increasing infection risk
5. 5 -- Best practice statements for antibiotic prophylaxis in urological procedures
6. 6 -- Antibiotic prophylaxis regimens in ureteroscopy
7. 7 -- Antibiotic prophylaxis regimens in percutaneous nephrolithotomy
8. 8 -- Stone volume calculation formula
9. 9 -- EAU Infection Severity Scale