What question did this study set out to answer?

This study aims to compare two durations of antibiotic prophylaxis in preventing infections after retrograde intrarenal surgery in high-risk patients.

January 10, 2026World Journal of Urology1 citationsOpen Access

Enhanced versus extended preoperative antibiotic prophylaxis for retrograde intrarenal surgery in high infectious risk patients: a randomized controlled trial

Q: What does this research mean for the field?

Enhanced (2 days) antibiotic prophylaxis is comparable to extended (7 days) prophylaxis in preventing post-RIRS infectious complications in high-risk patients. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

AEAmr A. Elsawy ENEhab A. Nour ANAdel Nabeeh

Key Result

Enhanced (2 days) antibiotic prophylaxis was comparable to extended (7 days) in preventing post-RIRS infectious complications in high-risk patients (36% vs 24%, P=0.81).

Key Points

This study aims to compare two durations of antibiotic prophylaxis in preventing infections after retrograde intrarenal surgery in high-risk patients.
Conducted a randomized controlled trial with 145 high-risk patients.
Patients were assigned to enhanced (2 days) or extended (7 days) antibiotic groups.
Primary outcome was the incidence of postoperative infectious complications.
Univariate and multivariate statistical analyses identified risk factors for infections.
Post-RIRS infectious complication rates were 36% in the enhanced group and 24% in the extended group.
No significant differences in complication grades or hospital stays between the groups.
Preoperative pyuria and lengthy ureteral stents were identified as independent risk factors for infections.

Structured PICO

Does enhanced (2 days) antibiotic prophylaxis reduce post-RIRS infectious complications compared to extended (7 days) antibiotic prophylaxis in high-risk patients undergoing retrograde intrarenal surgery?

Population

145 adults (age ≥18 years) with renal stones (maximum diameter ≤20 mm) planned for retrograde intrarenal surgery (RIRS) who are at high risk for infectious complications (preoperative asymptomatic bacteriuria, indwelling ureteral stent >4 weeks, or diabetes mellitus).

Intervention

Enhanced antibiotic prophylaxis (2 days) prior to retrograde intrarenal surgery.

Comparator

Extended antibiotic prophylaxis (7 days) prior to retrograde intrarenal surgery.

Outcome

Incidence of postoperative infectious complications (defined as ≥ grade 2 according to Infection Severity Scale by the European Association of Urology).safety

A 2-day enhanced antibiotic prophylaxis protocol is comparable to a 7-day extended protocol in preventing infectious complications after retrograde intrarenal surgery in high-risk patients.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

OBJECTIVES: To compare enhanced (2 days) antibiotic prophylaxis (AP) versus extended (7 days) AP in terms of rate and grade of infectious complications post RIRS in high-risk patients. In addition, we aimed to identify the risk factors related to these devastating complications. PATIENTS AND METHODS: After institutional review board (IRB) approval, 145 patients were randomized into two groups; enhanced and extended groups. Baseline clinical, laboratory and radiological characteristics were compared between the two groups. Primary outcome was incidence of post-RIRS infectious complications. Secondary outcomes comprised length of hospital stay, stone free rate (SFR), unplanned visits and hospital readmissions. Univariate and multivariate logistic regression analyses were utilized to identify independent predictors of post-RIRS infectious complications. RESULTS: The two study groups were comparable for preoperative baseline patients’ and stone characteristics. Asymptomatic bacteriuria, diabetes mellitus and lengthy dwelling ureteral stents were identified in 66 (45.5%), 51 (35%) and 113 (78%) patients, respectively. The rate of post-RIRS infectious complications was comparable between the two groups (36% in enhanced group and 24% in extended group, P = 0.81). There were no differences between the two groups in terms of grade of infectious complications or infected postoperative urine culture (P = 0.74, and 0.06, respectively). Length of stay, SFR and unplanned visits and hospital readmissions were statistically comparable between the two groups. On multivariate analysis, only preoperative pyuria and lengthy dwelling ureteral stents were independently associated with increased risk of post-RIRS infectious complications regardless the AP duration (relative risk 95%CI, p value = 1.49 1.22–1.83, 0.01 and 1.42 1.15–1.76, 0.02, respectively). CONCLUSIONS: Prior to RIRS in high-risk patients for infectious complications, enhanced (2 days) AP was shown comparable to extended (7 days) AP in terms of rate and grade of infectious post-operative events. Preoperative pyuria and lengthy dwelling ureteral stents were independent risk factors for post-RIRS infectious complications regardless the AP duration. TRIAL REGISTRATION: Clinicaltrials.gov ID: NCT05384197.

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