ORLANDO, FL USA (UroToday.com) - Usually preoperative urinalysis (UA) and urine culture are obtained before percutaneous nephrolithotomy (PCNL), and positive UC should be adequately treated prior to percutaneous surgery.
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In clinical practice, a number of preoperative urine cultures may be contaminated, incorrectly stored or incorrectly processed. Given this Leavett and colleagues from Smith Institute conducted a study to determine if a completely negative urine dipstick analysis (UDA), negative UA or almost negative UA was sufficient to predict a low chance of postoperative sepsis.
In this study preoperative UDA and UA was available in 291 patients. Parameters on UDA analyzed included the presence of blood, nitrites and leukocyte esterase (LE). Parameters on UA included all those on UDA in addition to the amount of bacteria, squamous epithelial cells, red blood cells (rbc) and white blood cells (wbc). Postoperative fevers, sepsis and intensive-care unit (ICU) admission were determined for all patients. Almost negative UDA was defined as negative/trace blood, negative nitrites, and negative/trace LE. Almost negative UA was defined as negative/trace blood, negative nitrites, negative/trace LE, and < 5 rbcs. We defined postoperative sepsis as having postoperative blood cultures drawn, as this is routinely done at our hospital if there is suspicion a patient is developing post-PCNL sepsis.
Of negative and almost negative UDA, a single patient developed sepsis by our inclusion criteria, however on further chart review this patient had a negative blood culture and did not meet sepsis criteria. Ten patients (3.4%) had completely negative UA and none develop sepsis, fevers or ICU admission. Up to 35 (12%) patients had almost negative UA and none of them developed sepsis, fevers or ICU admission.
Preoperative UDA and UA are rarely negative in patients undergoing PCNL. It appears that a completely negative UDA or UA is not associated with postoperative sepsis and when totally negative may be sufficient as a preoperative screening technique for percutaneous renal surgery.
Presented by David Leavett, MD at the American Urological Association (AUA) Annual Meeting - May 16 - 21, 2014 - Orlando, Florida USA
New York, NY USA
Written by Zhamshid Okhunov, MD, University of California (Irvine), and medical writer for UroToday.com,