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Purpose To assess the feasibility of sparing routine antibiotic prophylaxis in patients without preoperative urinary tract infection (UTI) undergoing a ureterorenoscopy (URS) for stone removal. Patients and Methods A retrospective, monocentric study was conducted to evaluate the outcome of a modified perioperative antibiotic management strategy according to the principles of antibiotic stewardship (ABS). Patients with preoperative unremarkable urine culture received no antibiotic prophylaxis for ureterorenoscopic stone removal (NoPAP). The NoPAP group was compared to a historic URS cohort, when antibiotic prophylaxis was standard of care. Analysis focused on postoperative complications. Results Postoperative fever occurred in 1% of the NoPAP and 2% of the PAP patients (p= 0.589). Clavien 1-3 complications did not differ between groups with 9% in the NoPAP and 6.2% in the PAP (p= 0.159). No Clavien 4-5 complications were seen. We identified a residual stone (p=0.033) and an ASA-Score 3-4 (p=0.004) as significant risk factors for postoperative fever. By sparing routine antibiotic prophylaxis the overall antibiotic usage was reduced from 100% (PAP) to 8.3% (NoPAP). Conclusion Sparing a routine antibiotic prophylaxis during URS for stone removal seems feasible in patients with unremarkable preoperative urine culture for most of the patients. A prospective validation is warranted.

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