Infective outcomes of semi-rigid ureteroscopy in patients with positive preoperative leucocyte esterase: a retrospective analysis

Mohamad, Abdul Malek and Mohamed Sufian, Mohamad 'Arif Rukaini and Kamarulzaman, Mohd Nazli and Ab Rashid, Islah Munjih (2026) Infective outcomes of semi-rigid ureteroscopy in patients with positive preoperative leucocyte esterase: a retrospective analysis. The Interventionalist Journal, 6 (1). pp. 5-13. E-ISSN 2785-8944

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Abstract

Background: Ureteroscopy (URS) is the standard treatment for ureteral pathologies such as urolithiasis, but it carries a risk of postoperative infectious complications.1,2 Screening for urinary tract infection (UTI) using leucocyte esterase (LE) on urine dipstick is routinely performed; however, LE may yield false-positive results in the presence of stone-related inflammation.2,3 This creates a clinical dilemma when urine culture and sensitivity (C&S) results are not immediately available.³ This study aimed to evaluate the safety of proceeding with semirigid URS based on clinical assessment and dipstick findings, with retrospective review of culture results. Methods: This retrospective cohort study analyzed 231 patients who underwent semi-rigid URS at Sultan Ahmad Shah Medical Centre between December 2018 and December 2023. All patients had positive preoperative LE but negative nitrite and no clinical signs of infection. Surgical timing was determined by dipstick findings rather than awaiting C&S results, with culture data reviewed retrospectively. Results: Postoperative urinary tract infection occurred in 16 patients (6.9%). Only 18 patients had positive urine cultures upon retrospective review, indicating a 92.2% discrepancy rate between LE positivity and true bacteriuria. Multivariate logistic regression identified positive urine culture and prior history of UTI as the independent predictors of postoperative infection. Conclusion: Semi-rigid URS can be performed safely in patients with positive preoperative LE when clinical assessment and negative nitrite do not indicate active infection. The substantial discrepancy between LE and C&S supports a pragmatic approach of not delaying surgery for LE positivity alone, while retrospective C&S data are effective for postoperative risk stratification.

Item Type:	Article (Journal)
Uncontrolled Keywords:	ureteroscopy, leucocyte esterase, urinary tract infection, URS
Subjects:	R Medicine > RD Surgery
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Medicine Kulliyyah of Medicine > Department of Surgery
Depositing User:	Dr Islah Munjih Bin Ab. Rashid
Date Deposited:	24 Sep 2026 16:27
Last Update:	24 Sep 2026 16:27
Queue Number:	2026-09-Q5249
URI:	http://irep.iium.edu.my/id/eprint/131478
Indexed In:	Google Scholar

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