Urine culture–guided antibiotic prophylaxis reduces febrile pyelonephritis after ureteral stent removal following radical cystectomy

TL;DR

Using urine culture results to choose antibiotics before removing a stent after bladder cancer surgery lowers the risk of kidney infections.

Contribution

Urine culture–guided antibiotic prophylaxis is shown to reduce febrile pyelonephritis after stent removal in cystectomy patients.

Findings

Culture-guided prophylaxis reduced febrile pyelonephritis from 16% to 3%.

Urine culture–guided selection was an independent protective factor against infection.

Enterococcus faecalis was the most common pathogen isolated.

Abstract

To evaluate whether urine culture–guided prophylactic antibiotic selection reduces infectious complications after ureteral stent removal following radical cystectomy with intestinal urinary diversion.

We retrospectively analyzed 128 patients who underwent radical cystectomy with intestinal urinary diversion between February 2009 and July 2025. Patients were divided into a culture-guided prophylaxis group and an empirical prophylaxis group. The primary endpoint was febrile pyelonephritis after ureteral stent removal. Multivariable logistic regression analysis was performed to identify independent risk factors for post–stent removal infection.

Patients in the culture-guided group more frequently received antithrombotic therapy, neoadjuvant chemotherapy, and robot-assisted surgery, and had shorter operative times and less blood loss. Febrile pyelonephritis occurred in 2 patients (3%) in the culture-guided group and 10 patients (16%) in the empirical group (P < 0.05). Enterococcus faecalis was the most commonly isolated pathogen. Multivariable analysis identified urine culture–guided prophylactic antibiotic selection as an independent protective factor against febrile pyelonephritis (odds ratio 0.139, P = 0.04), while antithrombotic therapy was an independent risk factor.

Urine culture–guided prophylactic antibiotic selection before ureteral stent removal significantly reduced febrile pyelonephritis after radical cystectomy with intestinal urinary diversion, supporting its use as an effective infection prevention strategy in this high-risk population.

The online version contains supplementary material available at 10.1007/s00345-026-06334-z.

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