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World J Urol. 2019 Oct 23. doi: 10.1007/s00345-019-02977-3. [Epub ahead of print]

Treatment of non-obstructive, non-struvite urolithiasis is effective in treatment of recurrent urinary tract infections.

Author information

1
Department of Urology, Mayo Clinic, Rochester, MN, USA.
2
Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
3
Division of Urology, Penn State Health, Hershey, PA, USA.
4
Department of Urology, Mayo Clinic, Rochester, MN, USA. mrivera7@iuhealth.org.
5
, 1801 N Senate Blvd, Ste 220, Indianapolis, IN, 46202, USA. mrivera7@iuhealth.org.

Abstract

PURPOSE:

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.

KEYWORDS:

Endourology; Nephrolithiasis; Percutaneous nephrolithotomy; Ureteroscopy; Urinary tract infections

PMID:
31646382
DOI:
10.1007/s00345-019-02977-3

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