Urosepsis is a potential life-threatening complication of minimally invasive endourological procedures. High discordance rates exist between bladder urine cultures and cultures from the upper tract (renal pelvis and stones cultures). Aim of this systematic review is to summarise the evidence on the clinical value of pre-operative bladder urine culture (PBUC), renal pelvis urine culture (RPUC) and stone cultures (SC) in predicting post-operative infective complications after URS or PCNL.
A systematic review was performed in accordance to the PRISMA guidelines. The PICO model of the clinical search question was: Patients - patients undergoing PCNL or URS; Intervention - intra-operative RPUC and SC; Comparison - compared to pre-operative BUC; Outcome - prediction of post-operative systemic inflammatory response syndrome (SIRS) or sepsis. Studies included were published between 2004 and 2024.
21 studies were included. PBUC was shown to have a poor concordance rate with intra-operative cultures. PBUC had a lower value in predicting post-operative SIRS and sepsis compared to intra-operative cultures. A significant concordance rate was found between RPUC and SC. SC were the best predictors of the development of post-operative SIRS and urosepsis.
A pre-operative bladder urine culture is often not representative of the upper tract microbiological environment. Collecting renal pelvis urine cultures and stone cultures during RIRS and PCNL should be the standard of care, especially in high risk patients.
World journal of urology. 2025 Jul 17*** epublish ***
Francesco Ripa, Ayah Atiya, Alberto Quistini, Clara Cerrato, Vineet Gauhar, Bhaskar Somani
Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK. ., Department of Urology, Homerton Healthcare NHS Foundation Trust, London, UK., Department of Urology, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy., Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK., Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore.