Assessing the Safety of Omitting Routine Preoperative Urine Cultures in Asymptomatic Patients Undergoing Urological Surgery
Submission: 07 August 2025 | Acceptance: 10 October 2025 | Publication: 25 December 2025
Muhammad Shahzad1, Neelam Iqbal2, Ehtesham Malik Khan3, Hamza Ashraf4, Ehsan Ul Islam4, Muhammad Faridullah Thaimur1
1Ayub Teaching Hospital, Abbottabad
2Abbottabad International Medical College, Abbottabad
3Benazir Bhutto Shaheed Teaching Hospital, Abbottabad
4Women Medical College, Abbottabad
Corresponding Author: Dr Neelam Iqbal, Abbottabad International Medical College, Abbottabad
ABSTRACT
Background: Urinary stone disease is a prevalent clinical concern, with incidence varying across regions. Minimally invasive procedures—shockwave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PCNL)—are commonly used but carry a risk of postoperative infection. The necessity of routine preoperative urine cultures in asymptomatic patients remains uncertain, especially when dipstick testing shows no evidence of infection.
Objective: This study examined whether omitting preoperative urine cultures in asymptomatic patients with negative nitrite dipstick results affects infection rates following SWL, URS, or PCNL.
Methods: We retrospectively analyzed 268 patients treated between July 2023 and June 2024. All had negative nitrite results on preoperative dipstick testing and no recent history of urinary tract infection. Patients underwent SWL (n=80), URS (n=113), or PCNL (n=75). We reviewed postoperative records for UTIs, febrile episodes, and related outcomes. Results: No infections or fevers occurred in the SWL group. Among URS patients, 1.8% developed UTIs after stent removal. In the PCNL group, 8.0% experienced postoperative fevers, though none had confirmed bacteremia or bacteriuria. The overall incidence of UTIs and febrile episodes was 0.7% and 2.2%, respectively.
Conclusion: For patients without urinary symptoms and negative nitrite dipstick results, routine preoperative urine cultures may be unnecessary. Adopting a selective approach could help reduce antibiotic overuse and unnecessary testing, aligning with antimicrobial stewardship goals.
Keywords: Urolithiasis; Asymptomatic Bacteriuria; Preoperative Screening; Postoperative Infection; Antimicrobial Stewardship; Endourology