Risk Factors of Infectious Complications following Ureteroscopy: A Systematic Review and Meta-Analysis

Objective: To investigate the potential risk factors of infectious complications following ureteroscopy (URS). Materials and Methods: Studies reporting risk factors of infectious complications following URS were searched via PubMed, EMBASE, Cochrane Library, and Web of Science databases up to August 30, 2019. OR or mean difference (MD) with 95% CI was calculated to assess the potential risk factors. Results: A total of 14 studies containing 9,532 patients were included. Positive preoperative urine culture was the most significant risk factor (OR 2.95, 95% CI 1.96-4.43, p < 0.01), followed by female gender (OR 1.95, 95% CI 1.48-2.57, p < 0.01), diabetes mellitus (OR 1.55, 95% CI 1.13-2.13, p < 0.01), pre- and postoperative stent (OR 1.53, 95% CI 1.11-2.11, p = 0.01, OR 1.44, 95% CI 1.01-2.03, p = 0.04, relatively), and extended operative time (MD -11.54, 95% CI -16.10 to 6.98, p < 0.01). Age (MD -2.59, 95% CI -5.36 to 0.18, p = 0.07), cumulative stone diameter (MD -1.54; 95% CI -4.63 to 1.55, p = 0.33), and renal insufficiency (OR 1.22, 95% CI 0.80-1.88, p = 0.36) were not the potential risk factors. Conclusion: The prevalence of infectious complications following URS was correlated with female gender, diabetes mellitus, preoperative urine culture, pre- and postoperative stent insertion, and extended operative time. Publication bias and high heterogeneity were observed in some risk factors. Further studies are warranted for a valid conclusion.