Fever after shockwave lithotripsy-risk factors and indications for prophylactic antimicrobial treatment

Mordechai Duvdevani, Gideon Lorber, Ofer N. Gofrit, Arie Latke, Ran Katz, Ezekiel H. Landau, Shimon Meretyk, Amos Shapiro, Dov Pode

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12 Scopus citations

Abstract

Purpose: To identify risk factors for fever after shockwave lithotripsy (SWL) and suggest guidelines for prophylactic antimicrobial treatment. Patients and Methods: Between 1985 and 2007, a total of 15,324 SWL procedures were performed in our institution using the Dornier HM3 lithotripter. Because stone analyses were not available in the majority of patients, management of stones larger than 2cm in diameter were excluded from this analysis to minimize the ratio of struvite stones as a possible cause for postprocedural fever. In this analysis, 11,500 SWL treatments were included. Clinical parameters before, during, and after treatments were prospectively registered using a computerized database. Potential risk factors for fever after SWL were evaluated. Results: Fever >38.0°C developed in 161 (1.4%) patients. The risk factors for fever after SWL were: A positive urine culture (P<0.05), an indwelling nephrostomy tube or stent during the procedure (P<0.001), lithotripsy of kidney or upper ureteral stones (P<0.05) and preoperative symptomatic urinary tract infection (UTI) (P<0.05) or sepsis (P<0.05). Lithotripsy of mid and lower ureteral stones, stone size, and the use of ureteral catheters during the procedures were not associated with increased risk of fever after SWL. Conclusions: Fever (>38.0°C) develops in only 1.4% of the patients undergoing SWL. Therefore, prophylactic antibiotic treatment is not indicated in all patients. Selective prophylactic treatment is recommended in patients who present with UTI, kidney or upper ureteral stones, and those for whom a nephrostomy tube or stent is necessary.

Original languageEnglish
Pages (from-to)277-281
Number of pages5
JournalJournal of Endourology
Volume24
Issue number2
DOIs
StatePublished - 1 Feb 2010
Externally publishedYes

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