Generally speaking, SWL has a low infection rate, but the procedure should be avoided if there is an active infection. The infection rate for URS is slightly higher than that of SWL, but it is still relatively low. Dr. Schwartz emphasized that postoperative antibiotics may not affect the incidence of postoperative fever in URS. Infection is more common in PCNL than in SWL or PCNL, and patients with a sterile preoperative urine sample may still go on to develop infections. Dr. Schwartz stressed that appropriate drainage (nephrostomy tube, ureteral stent, etc.) is essential in reducing the risk of infection. A summary of high-level evidence EAU guidelines is pictured below.
Dr. Schwartz noted that there is a lack of good data to guide the use of antibiotics in patients with special characteristics that may put them at higher risk for infection (e.g., immunosuppression, age, congenital urinary tract abnormalities, etc.). While he does not expect much to change in the coming 2019 EAU guidelines, he does expect these special situations to be better addressed.
Presented by: Bradley Schwartz, DO, Illinois University
Written by: Frank Jefferson, Department of Urology, University of California-Irvine, medical writer for UroToday.com at the 36th World Congress of Endourology (WCE) and SWL - September 20-23, 2018 Paris, France