Purpose
Abstract
To determine if treatment of non-obstructing urolithiasis is effective in management of recurrent UTI.
Materials and methods
A retrospective review was performed of patients undergoing elective management of non-struvite upper tract urinary calculi with recurrent UTI from 2009 to 2016. Recurrent UTI was defined at ≥ 3 UTI in 12 months, with symptoms and documented urine culture. Preoperative CT was performed in all patients to determine stone burden. All patients had postoperative imaging and ≥ 12 months of follow-up. Pre- and postoperative variables were between patients who had recurrent UTI after treatment versus those who did not.
Results
46 patients met inclusion criteria. 42 (91.3%) were female. Median age was 63.7 years (IQR 49.1, 73.4) and median total stone burden was 20 mm (IQR 14–35). Within the cohort, 20 (43.5%) underwent ureteroscopy only, 26 (56.5%) underwent PCNL ± URS, and none underwent ESWL. Median postoperative follow-up was 2.9 years (IQR 2.0, 4.3). Only five patients (10.9%) had recurrent UTI after treatment. 80% were with the preoperative pathogen. The presence of residual stone was an independent risk factor for recurrent UTI after treatment (p < 0.046). Diabetes, hypertension, immunosuppression and chronic kidney disease were not.
Conclusions
Stone removal for patients with recurrent UTIs was associated with a high rate of success (89.1%) in elimination of further recurrent UTIs. Residual fragments are independently associated with persistent recurrent UTIs and thus, complete stone removal is of paramount importance in treatment of this patient population.
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References
Foxman B, Barlow R, D’Arcy H, Gillespie B, Sobel JD (2000) Urinary tract infection: self-reported incidence and associated costs. Ann Epidemiol 10:509–515
Mabeck CE (1972) Treatment of uncomplicated urinary tract infection in non-pregnant women. Postgrad Med J 48:69–75
Griebling TL (2005) Urologic diseases in America project: trends in resource use for urinary tract infections in women. J Urol 173:1281–1287
Griebling TL (2005) Urologic diseases in America project: trends in resource use for urinary tract infections in men. J Urol 173:1288–1294
Barr-Beare E, Saxena V, Hilt EE et al (2015) The Interaction between Enterobacteriaceae and calcium oxalate deposits. PLoS One 10:e0139575
Rocha H, Santos LC (1969) Relapse of urinary tract infection in the presence of urinary tract calculi: the role of bacteria within the calculi. J Med Microbiol 2:372–376
Chih-Yen H, Hsing-Lin LIN, Yen-Ko LIN et al (2014) Urinary tract infection in patients with chronic kidney disease. Turk J Med Sci 44:145–149
Varda BK, McNabb-Baltar J, Sood A et al (2015) Urolithiasis and urinary tract infection among patients with inflammatory bowel disease: a review of US emergency department visits between 2006 and 2009. Urology. 85:764–770
Abbo LM, Hooton TM (2014) Antimicrobial stewardship and urinary tract infections. Antibiotics (Basel, Switzerland) 05(3):174–192
Omar M, Abdulwahab-Ahmed A, Chaparala H, Monga M (2015) Does stone removal help patients with recurrent urinary tract infections? J Urol 194:997–1001
Cui X, Ji F, Yan H et al (2015) Comparison between extracorporeal shock wave lithotripsy and ureteroscopic lithotripsy for treating large proximal ureteral stones: a meta-analysis. Urology 85:748–756
Fankhauser CD, Hermanns T, Lieger L et al (2018) Extracorporeal shock wave lithotripsy versus flexible ureterorenoscopy in the treatment of untreated renal calculi. Clin Kidney J 11(3):364–369
de Cógáin MR, Lieske JC, Vrtiska TJ, Tosh PK, Krambeck AE (2014) Secondarily infected nonstruvite urolithiasis: a prospective evaluation. Urology 84:1295–1300
Paonessa JE, Gnessin E, Bhojani N, Williams JC Jr, Lingeman JE (2016) Preoperative bladder urine culture as a predictor of intraoperative stone culture results: clinical implications and relationship to stone composition. J Urol 196:769–774
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DKA: Protocol/project development, Data collection, data analysis, manuscript writing and editing; AEK: Protocol/project development, Data collection, manuscript writing and editing; VS: Data analysis, manuscript writing and editing; FJM: Data collection, manuscript writing and editing; MEW: Data analysis; JJK: Manuscript editing; MER: Protocol/project development, Data collection, data analysis, manuscript writing and editing.
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AEK—Paid consultant for Lumenis and Boston Scientific. Non-paid consultant for Thermadex. No other authors have disclosures.
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Agarwal, D.K., Krambeck, A.E., Sharma, V. et al. Treatment of non-obstructive, non-struvite urolithiasis is effective in treatment of recurrent urinary tract infections. World J Urol 38, 2029–2033 (2020). https://doi.org/10.1007/s00345-019-02977-3
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DOI: https://doi.org/10.1007/s00345-019-02977-3