AUA 2018: Treatment of Non-Obstructive Urolithiasis is Effective in Treatment of Recurrent Urinary Tract Infections

San Francisco, CA USA ( Deepak Agarwal, MD, a clinical urologist from the Mayo Clinic in Rochester Minnesota, presents his research on the treatment of non-obstructive urinary calculi to treat recurrent urinary tract infections (UTIs). Patients who present with these two conditions are particularly challenging patients to treat and are associated with a significant morbidity and cost. According to Dr. Agarwal, there has been growing evidence that the surgical removal of these non-obstructing stones may be beneficial to the treatment of recurrent UTIs. Additionally, it has been shown in previous research that kidney stones can be colonized with bacteria despite appropriate antibiotic administration. Therefore, Dr. Agarwal and his team sought to determine whether or not these procedures are effective.

This study featured the retrospective review of patients undergoing ablation of non-obstructing renal stones for treatment of recurrent UTI between 2010-2016. Preoperative demographics, operative characteristics, and postoperative follow-up data was obtained and assessed. A UTI that occurred within the first 30 days postoperatively was considered a postoperative complication and not UTI recurrence. If a patient develops ≥ 3 UTIs within a single year would be considered recurrent.

At the study’s completion, 46 total patients were recruited retrospectively. The mean stone burden was 20 mm for the cohort with a range from 14 to 35 mm. Forty three percent of patients underwent URS only with no ESWL, while 22% required a second procedure for stone removal. Thirty nine percent of patients had residual stones and two patients experienced sepsis postoperatively. Of these patients, 53% had a positive stone culture during postoperative analysis. For the postoperative follow up data, the median follow-up time frame was 2.9 years with a range from 2 to 4.3 years. Of the observed patient cohort, 50% experienced a UTI after 30 days, and 11% (n=5) of the total cohort were deemed to have recurrent UTIs after stone removal according to the previously explained definition. Of these 5 patients with recurrence, 80% experienced the recurrence within one year and 80% also had the same culture as the original preoperative pathogen.

To conclude his presentation, Dr. Agarwal believes that removal of non-obstructing renal stones may be beneficial to the treatment of patients suffering from recurrent UTI. He recommended to the surgeons in the audience that the goal of the surgery should be to ensure that the patient is completely stone free.

Presented by: Deepak Agarwal, MD

Written by: Zachary Valley, Department of Urology, University of California-Irvine at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA