Yoshida S 1 1 Department of Urology, Kidney Stone Center, Tokyo Metropolitan Ohtsuka Hospital, 2-8-1 Minami-Ohtsuka, Toshimaku, Tokyo, 170-8476, Japan , Takazawa R 2 2 Department of Urology, Kidney Stone Center, Tokyo Metropolitan Ohtsuka Hospital, 2-8-1 Minami-Ohtsuka, Toshima-ku, Tokyo, 170-8476, Japan , Uchida Y 1 1 Department of Urology, Kidney Stone Center, Tokyo Metropolitan Ohtsuka Hospital, 2-8-1 Minami-Ohtsuka, Toshimaku, Tokyo, 170-8476, Japan , Kohno Y 1 1 Department of Urology, Kidney Stone Center, Tokyo Metropolitan Ohtsuka Hospital, 2-8-1 Minami-Ohtsuka, Toshimaku, Tokyo, 170-8476, Japan , Waseda Y 1 1 Department of Urology, Kidney Stone Center, Tokyo Metropolitan Ohtsuka Hospital, 2-8-1 Minami-Ohtsuka, Toshimaku, Tokyo, 170-8476, Japan , Tsujii T 1 1 Department of Urology, Kidney Stone Center, Tokyo Metropolitan Ohtsuka Hospital, 2-8-1 Minami-Ohtsuka, Toshimaku, Tokyo, 170-8476, Japan
COMMENT
Infectious complications are among the most feared complications of retrograde intrarenal surgery (RIRS). Untreated positive pre-operative bladder urine culture (PBUC) is a contraindication for RIRS, but infectious complications may occur even with prophylactic antibiotics and negative PBUC (11. Türk C, Petrík A, Sarica K, Seitz C, Skolarikos A, Straub M, Knoll T. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol. 2016;69:475-82.). The role of renal pelvic urine culture (RPUC) and stone culture (SC) are well known in patients undergoing percutaneous nephrolithotomy (22. Mariappan P, Smith G, Bariol SV, Moussa SA, Tolley DA. Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy: a prospective clinical study. J Urol. 2005;173:1610-4.). However, its role in RIRS is not established.
This prospective study investigated the associations among the results of PBUC, RPUC, and SC. PBUC was positive in 49.6% of the patients. Even after adequate antibiotic administration, RPUC was positive in 19.2% and SC was positive in 15.2% of the patients. Moreover, bacterial species detected by PBUC were not necessarily consistent with those of RPUC and/or SC. Systemic inflammatory response syndrome (SIRS) occurred in 10.3% of the patients. Female gender (OR=2.81), struvite calculi (OR=4.95) and positive RPUC (OR=3.83) were significant risk factors of SIRS after RIRS.
Therefore, obtaining a RPUC during RIRS is highly recommended because it can be useful for selecting appropriate antibiotics.
REFERENCES
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1Türk C, Petrík A, Sarica K, Seitz C, Skolarikos A, Straub M, Knoll T. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol. 2016;69:475-82.
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2Mariappan P, Smith G, Bariol SV, Moussa SA, Tolley DA. Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy: a prospective clinical study. J Urol. 2005;173:1610-4.
Publication Dates
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Publication in this collection
31 July 2020 -
Date of issue
Sep-Oct 2020
