To determine if treatment of non-obstructing urolithiasis is effective in management of recurrent UTI.
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.
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.
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.
World journal of urology. 2019 Oct 23 [Epub ahead of print]
Deepak K Agarwal, Amy E Krambeck, Vidit Sharma, Francisco J Maldonado, Mary E Westerman, John J Knoedler, Marcelino E Rivera
Department of Urology, Mayo Clinic, Rochester, MN, USA., Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA., Division of Urology, Penn State Health, Hershey, PA, USA., Department of Urology, Mayo Clinic, Rochester, MN, USA. .