PURPOSE: To evaluate the impact of surgical extraction of non-obstructing asymptomatic stones on recurrent urinary tract infections, and identify predictors of patients who may be rendered infection-free.
MATERIALS AND METHODS: A retrospective chart review identified patients with recurrent UTIs that underwent surgical stone extraction and were rendered stone-free. Demographic variables as well as procedure, infectious etiology, stone composition, and SIRS rate were also recorded. Patients were divided into two groups; the 1st group had no evidence of recurrent infection following surgery while the 2nd group developed recurrent infection. Univariate analysis was performed using Wilcoxon's signed-rank test and Fisher's exact test. Logistic regression was used for multivariate analysis.
RESULTS: 120 patients with recurrent UTIs and a non-obstructive renal stone were identified. Surgical management included SWL (32%), URS (7%), and PCNL (61%). 48% (58/120) remained infection-free after surgery, while 52% (62/120) had a recurrence of infection. Factors associated with a higher risk of recurrent infections included type 2 DM (OR 1.73, p=0.01), hypertension (OR 2.8, p=0.007), and African-American ethnicity (OR13.7, p=0.009). E.coli infections were more likely to resolve (OR 0.34, p=0.01). In contrast, Enterococcus infections were more likely to persist (OR 2.5, p=0.04). Upon analysis via multiple logistic regression analysis, only race, HTN, and presence of E. coli infections were significant predictors of infection clearance.
CONCLUSIONS: 50% patients with recurrent UTIs and asymptomatic renal calculi may be rendered stone-free following extraction. Patients with risk factors for recurrent infections after surgery should be counseled that stone extraction might not eradicate their infection.
Written by:
Omar M, Abdulwahab-Ahmed A, Chaparala H, Monga M. Are you the author?
Glickman Urological & Kidney Institute - Cleveland Clinic Foundation, Cleveland, OH, United States.
Reference: J Urol. 2015 Apr 29. pii: S0022-5347(15)03896-3.
doi: 10.1016/j.juro.2015.04.096
PubMed Abstract
PMID: 25936865