Risk-Stratified Pre-Operative Urine Testing For Ureteroscopy Using a Modified Delphi Consensus Approach

Authors

• Suprita Krishna
• Stephanie Daignault-Newton
• Caitlin Seibel
• Jerison Ross
• Jessica Phelps
• John Michael DiBianco
• Laris Galejs
• Lynne McCormick
• Rene Frontera
• Robert Dimitrou
• Ronald Rubenstein, Corewell Health East
• Sabry Mansour
• Steven Lucas, Corewell Health East
• William Johnston, Corewell Health East
• 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 state that urinalysis must be performed prior to surgical intervention for nephrolithiasis. However, guidance on optimal urine testing timing and type is limited, particularly for patients with factors that may influence their risk profiles, such as stents, nephrostomy tubes (PCN), or bladder drainage, and current guidelines do not account for many real-world infection risk scenarios. We sought to develop a risk-stratified consensus roadmap for pre-operative urine testing in patients undergoing ureteroscopy (URS). METHODS: A modified Delphi consensus panel was convened through the Michigan Urological Surgery Improvement Collaborative Reducing Operative Complications from Kidney Stones (MUSICROCKS). Panelists evaluated common clinical scenarios, including (1)asymptomatic nephrolithiasis, (2) indwelling ureteral stent or PCN, and (3) mechanical bladder drainage i.e., foley, suprapubic tube (SPT) or intermittent straight catheterization (ISC). Consensus was achieved over three survey rounds (July-September 2025) and defined by stable responses across two consecutive 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. The panel agreed that patients with symptoms of urinary tract infection (UTI) should undergo urinalysis and culture; if positive, culture directed pre-operative antibiotics are recommended. For asymptomatic patients, a negative urinalysis alone was considered sufficient to proceed with URS. In patients with a stent or PCN placed for sepsis, repeat urine testing was recommended prior to URS regardless of dwell time. If placed for colic with negative cultures at the time of placement, repeat testing was also advised. No consensus was reached regarding urine testing modality. Patients with mechanical bladder drainage should undergo pre-operative urine culture (Figure1). CONCLUSIONS: Using a modified Delphi approach, we developed consensus recommendations for pre-operative urine testing for URS. This work highlights clear areas of agreement and future study. Ongoing efforts aim to create a risk-stratified framework to optimize testing type, timing, and antibiotic use, balancing infection prevention with antibiotic stewardship.

Volume

215

Issue

5S

First Page

e1275

Last Page

e1276

Recommended Citation

Krishna S, Daignault-Newton S, Seibel C, Ross J, Phelps J, DiBianco JM, et al. [Rubenstein R, Lucas S, Johnston W]. Risk-stratified pre-operative urine testing for ureteroscopy using a modified Delphia consensus approach. J Urol. 2026 May;215(5S):e1275-e1276. doi:10.1097/01.JU.0001191660.34244.02.30

Comments

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

DOI

10.1097/01.JU.0001191660.34244.02.30