Extended Ceftriaxone Prophylaxis and Postoperative Inflammation and Infection-Related Symptoms After Ureteral Lithotripsy with Negative Urine Cultures.

Postoperative inflammatory and infection-related manifestations can occur after rigid ureteroscopic lithotripsy (RUL), including in patients with negative preoperative urine cultures. Whether extending prophylaxis improves outcomes for clinically confirmed infections remains uncertain. To explore differences in postoperative inflammatory markers and infection-related manifestations between an extended preoperative ceftriaxone regimen and a single prophylactic dose in culture-negative patients undergoing RUL. This single-center exploratory study included 252 analyzed patients and was reported as randomized. The extended-regimen group (n = 122) received ceftriaxone at 2 g intravenously every 12 h for 3-7 days before surgery; the single-dose group (n = 130) received 2 g intravenously 30-60 min before surgery. No prospective sample size or power calculation was performed. WBC, NEUT%, CRP, and PCT were assessed preoperatively and on postoperative days 1 and 3. Exploratory, unadjusted time-specific comparisons were calculated from the reported summary statistics; these do not constitute a longitudinal repeated-measures analysis. Clinical manifestations, surgical complications, and discharge SF-36 scores were also summarized. Postoperative mean WBC, NEUT%, CRP, and PCT values were lower in the extended-regimen group on days 1 and 3 (all unadjusted, summary-based p < 0.001). Preoperative WBC also differed (p = 0.040), and stone diameter differed between groups (p = 0.025). The reported symptom composite occurred in 20/122 patients (16.4%) and 39/130 patients (30.0%), respectively (two-sided Fisher's exact p = 0.012). Group-specific confirmed-infection rates were not reported. Selected SF-36 domain scores were higher at discharge. Numerical longitudinal-model outputs and ceftriaxone-related adverse-event frequencies were not reported. Extended ceftriaxone prophylaxis was associated with lower postoperative inflammatory-marker values and fewer reported infection-related manifestations. These exploratory findings do not establish prevention of confirmed postoperative infection, equivalent ceftriaxone safety, or a basis for recommending routine prolonged prophylaxis. Confirmatory studies with prespecified analyses, verified infectious endpoints, and complete safety reporting are needed.