Is Neurogenic Bladder a Risk Factor for Febrile Urinary Tract Infection after Ureteroscopy and if so, Why?

To characterize the rate of febrile urinary tract infections (UTI) after ureteroscopy in patients with neurogenic bladder compared to those with physiologically normal bladders. While generally considered safe and effective, there is a growing body of evidence suggesting that patients with neurogenic bladder are at increased risk of infectious complications following ureteroscopy.

We performed retrospective chart review of those undergoing ureteroscopy in a single academically affiliated hospital system between June 2013 and May 2016. Information regarding neurogenic bladder status, culture results, bladder management and presence of upper tract decompression was collected. Postoperative febrile UTI was defined as a hospital admission within 1 week of surgery due to fever not attributable to another source.

Of 467 ureteroscopies, 44 (9.5%) were performed in the setting of neurogenic bladder. Febrile UTI rates were higher in patients with neurogenic bladder compared to control patients (9% vs 1.4%, p= 0.01) with significantly higher rates in those dependent on bladder catheterization. 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).

While infectious complications in the neurogenic population are likely multifactorial, the reliance on catheterization and thus colonization appears to be a significant factor and extends to non-neurogenic patients. These data suggest that bacterial colonization may be the significant underlying risk factor for febrile UTI after ureteroscopy.

Urology. 2017 Oct 19 [Epub ahead of print]

Craig E Stauffer, Elizabeth Snyder, Tin C Ngo, Christopher S Elliott