Consensus Based Antibiotic Strategies For Patients Undergoing Ureteroscopy

Authors

• Suprita Krishna
• Stephanie Daignault-Newton
• Caitlin Seibe
• Jerison Ross
• Amiya Alexander
• Alex Small
• Austin Fernstrum
• Hamza Beano, Corewell Health East
• Brian Seifman, Corewell Health East
• David Leavitt
• David Wenzler
• Dima Raskolnikov
• Gopal Narang
• Hector Pimentel, Corewell Health West
• Henry Rosevear, Corewell Health East
• Jaime Bartley
• Wilson Sui
• Khurshid Ghani
• Casey Dauw
• Michigan Urological Surgery Improvement Collaborative

Document Type

Conference Proceeding

Publication Date

5-2026

Publication Title

Journal of Urology

Abstract

INTRODUCTION AND OBJECTIVES: The American Urological Association guidelines recommend culture directed pre-operative antibiotics for patients with positive urine cultures prior to surgical intervention for nephrolithiasis. There is less clarity regarding optimal antibiotic duration, peri-operative selection, and the need for or duration of post-operative therapy. Balancing antibiotic use is particularly important for patients with factors that may influence their risk profiles, such as indwelling stents, nephrostomy tubes (PCN), or mechanical bladder drainage, and current guidelines do not address many real-world scenarios. We aimed to develop a risk-stratified consensus roadmap for antibiotic selection and duration in patients undergoing ureteroscopy (URS). METHODS: A modified Delphi consensus panel was convened through the Michigan Urological Surgery Improvement Collaborative. Panelists evaluated pre, peri, and post operative antibiotic use across three categories: (1) asymptomatic nephrolithiasis, (2) indwelling ureteral stent or PCN, and (3) mechanical bladder drainage (foley, supra-pubic tube, or intermittent catheterization). Consensus was reached over three survey rounds (July-September 2025) and defined by stable responses across two rounds and ≥80% agreement in rounds one and two or ≥70% in round three. RESULTS: Twenty-six of 32 panelists (81%) completed all rounds, representing both academic and community urologists. Consensus was achieved in 12 of 21 (57%) antibiotic-related scenarios. Agreement was strongest for uncomplicated kidney stones and for stents or nephrostomy tubes placed for colic or sepsis with negative pre-operative urine testing, where single-dose peri-operative antibiotics were recommended. In contrast, scenarios involving indwelling stents and mechanical bladder drainage and positive pre-operative urine cultures, panelists recommended culture directed pre-and peri-op antibiotics. For patients with mechanical bladder drainage and positive, asymptomatic (colonized) urine, the duration of pre-operative antibiotics should be limited to ≤3 days. Recommendations detailed in Figure 1. CONCLUSIONS: Using a modified Delphi process, we developed risk-stratified recommendations for antibiotic selection and duration in URS. This work defines areas of consensus and areas for further study to support antibiotic stewardship and infection prevention.

Volume

215

Issue

5S

First Page

e1272

Last Page

e1273

Recommended Citation

Krishna S, Daignault-Newton S, Seibel C, Ross J, Alexander A, Small A, et al. [Beano H, Seifman B, Pimentel H, Roseear H]. Consensus based antibiotic strategies for patients undergoing ureteroscopy. J Urol. 2026 May;215(5S):e1272-e1273. doi:10.1097/01.JU.0001191660.34244.02.22

Comments

American Urological Association Annual Meeting, May 15-18, 2026, Washington, DC

DOI

10.1097/01.JU.0001191660.34244.02.22