Efficacy and postoperative outcomes of kidney stone surgery in HIV-positive patients: A retrospective cohort study.

BACKGROUND: People living with HIV (PLWH) are increasingly undergoing endourological procedures, including mini-percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS), but comparative evidence on postoperative infectious outcomes is limited. OBJECTIVES: This study aims to compare short-term postoperative outcomes between PLWH and HIV-negative patients undergoing mini-PCNL or RIRS, focusing on postoperative urosepsis and exploring factors associated with urosepsis among PLWH. DESIGN: A single-center, retrospective cohort study. METHODS: Consecutive adult patients who underwent mini-PCNL or RIRS between July 2023 and January 2025 were grouped by HIV status. The primary outcome was postoperative urosepsis during the index hospitalization. Secondary outcomes included stone-free status and length of stay. RESULTS: A total of 708 patients were included (70 PLWH and 638 HIV-negative). Postoperative urosepsis occurred in 8/70 (11.4%) PLWH and 45/638 (7.1%) HIV-negative patients, with no significant difference between groups (p=0.13). Stone-free status was achieved in 66/70 (94.3%) PLWH and 586/638 (91.8%) HIV-negative patients (p=0.48). Other outcomes, including total hospitalization time, postoperative hospital stay, and preoperative antibiotic exposure, did not differ significantly between groups (all p>0.05). Among PLWH, exploratory univariable analyses showed that female sex, positive preoperative urine culture, and clinically higher-risk HIV disease group (acute HIV infection or AIDS) were associated with higher odds of postoperative urosepsis. CD4+ T-cell count <400 cells/µL showed a higher but statistically non-significant estimated odds. CONCLUSION: Short-term postoperative outcomes following mini-PCNL or RIRS did not differ significantly between PLWH and HIV-negative patients. Exploratory univariable analyses suggested that female sex, positive preoperative urine culture, and clinically higher-risk HIV disease group were associated with postoperative urosepsis among PLWH. These findings should be interpreted cautiously because of the limited number of PLWH and urosepsis events.