Chapter 45 · Postoperative and iatrogenic complications
Fever and sepsis after urological surgery
Definition
Fever after urological surgery may reflect tissue injury, but it may also be the first sign of infection and sepsis.
Clinical assessment
- Temperature > 38°C or < 36°C.
- Rigors, tachycardia, hypotension, confusion.
- Flank or lower back pain.
- Absent urine output.
Diagnosis
- CBC, CRP, procalcitonin, lactate.
- Urine and blood cultures.
- Ultrasonography to rule out obstruction, an abscess, and leakage.
- CT as indicated.
Emergency management
- Hemodynamic stabilization (fluids, vasopressors).
- Antibiotics (intravenous, broad-spectrum, guided by local resistance patterns).
- Rule out obstruction (ultrasonography, check drainage).
- Drain an abscess.
- Drain urinary leakage.
Algorithm
| Step | Action |
|---|---|
| 1 | Immediately: ABCDE, monitoring, organ dysfunction, lactate |
| 2 | In parallel: cultures, provided they do not delay treatment |
| 3 | In parallel: intravenous antibiotics according to the local protocol |
| 4 | In parallel: assess obstruction, leakage, abscess, and drain function |
| 5 | Obstruction or abscess: urgent source control |
| 6 | Fluid and vasopressor support; early ICU involvement |
Cross-references: Chapters 16–17.