Incidence of urinary infections and urosepsis after ureteroscopy for stone disease: a systematic review of literature

Background: Ureteroscopy (URS) and laser lithotripsy are commonly used to treat kidney and ureteric stones. Post-operative infections, including urinary sepsis, can be a potentially serious complication of URS. We aimed to systematically review the incidence and predictors of post-ureteroscopy infections and sepsis. Design: Systematic review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and registered prospectively with PROSPERO (CRD420251102349). Data sources and methods: Only studies in the English language with over 500 patients were included. The Population, Intervention, Comparison, Outcome (PICO) framework for this study examined inpatients with stone disease who underwent ureteroscopy to investigate the incidence of urinary infections and urosepsis. Results: Nineteen studies published between 2015 and 2024 were included, totalling 939,860 patients undergoing ureteroscopy for urolithiasis. Patient demographics varied, with a mean age range of 41.3-59.1 years and a male predominance (63.9%). Laser lithotripsy was the primary modality used, with a mean operative time of 53.4 min.The overall incidence of post-operative infectious complications was 7.8%, ranging from 0.8% to 18.2%. Fever (0.0%-16.2%) and urinary tract infections were the most commonly reported (0.0-12.3%), followed by sepsis (0.0%-7.0%) and septic shock (up to 1.9%). Identified risk factors included female gender, positive pre-operative urine cultures, pre-operative double-J stent placement, patient comorbidities and prolonged operative times. Conclusion: Infectious complications predominate among post-ureteroscopy complications. Key factors for post-ureteroscopy infections included female gender, patient comorbidities, positive pre-operative cultures and longer operative times, highlighting the need for targeted management strategies to reduce complications.