Patients with neurogenic bladder (NB) often require ureterorenoscopy (URS) for conditions such as urolithiasis and urothelial carcinoma. However, the postoperative outcomes of URS in this population remain underexplored. We hypothesize that NB patients experience higher rates of infectious complications and prolonged hospital stays compared to patients with non-neurogenic bladder (NNB). This study aims to evaluate and compare the perioperative outcomes of URS in these two patient groups.

A retrospective analysis was conducted on patients undergoing URS between October 2022 and December 2023. Patients were categorized into two groups: NB (N=36) and NNB (N=314). Demographic characteristics, surgical indications, and perioperative outcomes were analyzed. The primary outcomes included postoperative infectious failure (febrile episodes >38°C, inflammatory syndrome, hospitalization duration (>3 days), and 30-day readmission rates). Statistical analysis was performed to identify significant differences between groups.

The median age was significantly higher in the NB group (65 vs. 55 years, p<0.001). Males constituted 89% of the NB group and 68% of the NNB group (p=0.007). Urolithiasis was the primary indication for URS in both groups (NB: 92%, NNB: 90%, p=0.411).
Preoperative positive urine cultures were significantly more common in NB patients (39% vs. 15%, p<0.001).
Postoperative infectious failure was significantly more frequent in the NB versus NNB group (28% vs. 6%, p<0.001), consisting of fever (20% vs. 26%, p=0.086), inflammatory syndrome (20% vs. 32%, p<0.001), hospitalization rate >3 days (80% vs. 74%, p<0.001) and 30-day readmission rate (30% vs. 32%, p<0.001).

Patients with NB undergoing URS face a significantly higher risk of infectious failure, especially prolonged hospitalization, and readmission compared to NNB patients. This may be due to factors such as increased preoperative bacteriuria, impaired bladder emptying, and altered immune responses. The findings suggest that enhanced perioperative strategies, including tailored prophylactic antibiotics and closer postoperative monitoring, may be necessary to reduce complications.

Patients with neurogenic bladder face increased risks following URS, particularly infectious complications and prolonged hospital stays. Optimization with preoperative urine screening, targeted antimicrobial prophylaxis and infection control strategies should be prioritized to improve outcomes in this high-risk group.