The clinical utility of preoperative mid-stream urine culture (MSUC) in predicting fever and urinary tract infections (UTIs) after suction-assisted mini-percutaneous nephrolithotomy (SM-PCNL) remains debated.
This study aims to evaluate the correlation of postoperative fever and UTIs following SM-PCNL in patients with a positive preoperative MSUC versus those with a negative culture.
This was a retrospective analysis of a prospectively collected registry including 693 patients from the international STUMPS registry (30 centers and 21 countries).
Patients were stratified by preoperative MSUC results. All positive cultures were treated with targeted antibiotics for ⩾5 days as per the antibiogram; repeated negative cultures before surgery were not mandatory. Intraoperative parameters, 30-day postoperative complications, and stone-free rates (SFR) were evaluated. Multivariable logistic regression was performed to assess independent predictors of infectious complications.
Clavien-Dindo grade 1 postoperative fever occurred in 10.6% of patients with positive MSUC versus 4.6% in those with negative cultures. Clavien-Dindo grade 2 infections were more frequent in MSUC-positive patients (4.9% vs 1.2%). Sepsis requiring intensive care occurred in one patient per group. There was no difference in stone compositions and equivalent distribution of infectious stones in both. Intraoperative pelvic urine cultures were more frequently positive in patients with positive MSUC (5.7% vs 0.9%, p < 0.001). No differences were observed in major complications or SFR at 30 days. A positive preoperative MSUC was the only independent predictor of postoperative infection (OR 3.04; 95% CI 1.48-6.12; p = 0.01).
Positive preoperative MSUC is independently associated with a higher risk of postoperative fever and UTIs, particularly Clavien-Dindo grade 1 and 2 events, following SM-PCNL. Furthermore, these patients are more likely to have a positive intraoperative urine culture. Therefore, a preoperative MSUC should always be obtained, and a targeted antibiotic therapy should be administered irrespective of stone composition to reduce postoperative infectious risk.
Testing urine before kidney stone surgery helps predict the risk of infection after the procedure Kidney stones can cause pain and infections. A common treatment for large kidney stones is a procedure called suction-assisted mini-percutaneous nephrolithotomy (SM-PCNL), which removes stones through a small incision in the back. Even though it is less invasive, some patients develop infections after the surgery. Doctors often check a patient’s urine before surgery to see if there are bacteria that could cause infection. This test is called a mid-stream urine culture (MSUC). If the test is positive, antibiotics are given before surgery. However, it’s not always clear whether a positive test still means a patient is more likely to get an infection after surgery. In this study, we looked at 693 patients from 30 centers worldwide who had SM-PCNL. We compared those with positive urine cultures before surgery to those with negative cultures. We found that infections after surgery were more common in patients with a positive urine culture—even if they were given the right antibiotics ahead of time. These patients were also more likely to have bacteria in their kidneys during the procedure. Still, the overall success of the surgery in removing the stones was similar for both groups. This study shows that testing the urine before surgery is very important. Even with antibiotic treatment, patients with a positive result are more likely to develop infections. This information can help doctors identify patients who need extra care to reduce the risk of complications after kidney stone surgery.
Therapeutic advances in urology. 2025 Dec 10*** epublish ***
Angelo Cormio, Daniele Castellani, Bhaskar K Somani, Khi Yung Fong, Nitesh Kumar, Rajiv H Kalbit, Ivan Gorgotsky, Sundaram Palaniappan, Yiloren Tanidir, Zelimkhan Tokhtiyev, Lazaros Tzelves, Andreas Skolarikos, Esteban Acuña, Leonardo Gomes Lopes, Dmitriy Gorelov, Jaisukh Kalathia, Amish Mehta, Karl Tan, Pankaj Dholaria, Arun Chawla, Edgar Beltrán-Suárez, Zhu Wei, Thomas R W Herrmann, Steffi Kar-Kei Yuen, Vineet Gauhar
Department of Urology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Università Politecnica Delle Marche, Via Conca 71, Ancona 60126, Italy., Endourology Section of the European Association of Urology, Arnhem, The Netherlands., Department of Urology, Sengkang General Hospital, Singapore, Singapore., Department of Urology, Ford Hospital and Research Centre, Patna, Bihar, India., Department of Urology, Jose R. Reyes Memorial Medical Center, Manila, Philippines., Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia., Department of Urology, Medicana Atasehir Hospital, Istanbul, Turkey., Department of Urology and Andrology, IPPE of A.I. Burnazyan SSC FMBC, FMBA of Russia, Moscow, Russia., Second Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens, Athens, Greece., Department of Urology, Institution Hospital Provincial de Ovalle, Ovalle, Coquimbo, Chile., Department of Urology, Hospital Orizonti and Santa Casa de Belo Horizonte, Minas Gerais, Brazil., Department of Urology, First Saint-Petersburg State Medical University, Saint-Petersburg, Russia., Fortune Urology Clinic, Botad, Gujarat, India., B T Savani Kidney Hospital, Rajkot, Gujarat, India., Department of Urology, Veterans Memorial Medical Center, Quezon City, Philippines., Urology and Renal Transplant Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India., Department of Urology, Specialty Hospital La Raza, National Medical Center of the Mexican Institute of Social Security, Mexico City, Mexico., Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China., Endourology section of the European Association of Urology, Arnhem, The Netherlands.