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International Urology and Nephrology

, Volume 51, Issue 4, pp 585–591 | Cite as

Defining a clinically significant struvite stone: a non-randomized retrospective study

  • Amihay NevoEmail author
  • Mohammed Shahait
  • Anup Shah
  • Stephen Jackman
  • Timothy Averch
Urology - Original Paper
  • 43 Downloads

Abstract

Objective

To study the association between a stone’s struvite content and clinical outcomes and to determine a clinically significant cutoff for defining struvite stones.

Materials and methods

This was a retrospective study of all patients who underwent ureteroscopy or PCNL at our institution between 2012 and 2017 and had any component of struvite in the stone analysis. Patients were divided into four groups based on percent struvite content: A (1–25%), B (26–50%), C (51–75%), and D (76–100%). Bacterial characteristics were compared between groups. Univariate and multivariate analyses were performed to evaluate the association between struvite content and postoperative SIRS. Log-rank test was used to compare between the four groups’ recurrence rates.

Results

A total of 123 patients were included in the study. Positive preoperative urine culture was found in 31%, 81%, 87%, and 90% of patients from group A, B, C, and D, respectively. E. Coli was the most common pathogen in group A (54%), while Proteus was the most common pathogen in groups C (53%) and D (47%). Enterococci isolation rates remained similar between groups A-D, ranging from 23 to 33%. Postoperative SIRS occurred in 2.4%, 21.3%, 26.7%and 47.4% of the patients from groups A, B, C, and D, respectively, and was associated with struvite content and age on multivariate analysis. Increasing struvite content was associated with higher 2-year recurrence rate.

Conclusions

Higher struvite content is associated with a higher frequency of traditional urea splitting bacteria in urine culture, higher risk for postoperative SIRS, and higher recurrence rate. Struvite content greater than 25% can be used to define a clinically significant struvite stone.

Keywords

Infection Nephrolithiasis Struvite PCNL Ureteroscopy 

Notes

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest to declare.

References

  1. 1.
    Kuzgunbay B, Turunc T, Yaycioglu O, Kayis AA, Gul U, Egilmez T, Aygun C, Ozkardes H (2011) Percutaneous nephrolithotomy for staghorn kidney stones in elderly patients. Int Urol Nephrol 43(3):639–643CrossRefGoogle Scholar
  2. 2.
    Shafi H, Shahandeh Z, Heidari B et al (2013) Bacteriological study and structural composition of staghorn stones removed by the anatrophic nephrolithotomic procedure. Saudi J Kidney Dis Transplant 24(2):418–423CrossRefGoogle Scholar
  3. 3.
    Streem SB (1995) Long-term incidence and risk factors for recurrent stones following percutaneous nephrostolithotomy or percutaneous nephrostolithotomy/extracorporeal shock wave lithotripsy for infection related calculi. J Urol 153(3 Pt 1):584–587CrossRefGoogle Scholar
  4. 4.
    Rivera M, Viers B, Cockerill P, Agarwal D, Mehta R, Krambeck A (2016) Pre- and postoperative predictors of infection-related complications in patients undergoing percutaneous nephrolithotomy. J Endourol 30(9):982–986CrossRefGoogle Scholar
  5. 5.
    Iqbal MW, Shin RH, Youssef RF et al (2017) Should metabolic evaluation be performed in patients with struvite stones? Urolithiasis 45(2):185–192CrossRefGoogle Scholar
  6. 6.
    Parkhomenko E, De Fazio A, Tran T, Thai J, Blum K, Gupta M (2017) A multi-institutional study of struvite stones: patterns of infection and colonization. J Endourol 31(5):533–537CrossRefGoogle Scholar
  7. 7.
    Englert KM, McAteer JA, Lingeman JE, Williams JC Jr. (2013) High carbonate level of apatite in kidney stones implies infection, but is it predictive? Urolithiasis 41(5):389–394CrossRefGoogle Scholar
  8. 8.
    Dellinger RP, Levy MM, Rhodes A et al (2013 ) Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 41(2):580–637CrossRefGoogle Scholar
  9. 9.
    Flannigan R, Choy WH, Chew B, Lange D (2014) Renal struvite stones—pathogenesis, microbiology, and management strategies. Nat Rev Urol 11(6):333–341CrossRefGoogle Scholar
  10. 10.
    Bichler K-H, Eipper E, Naber K, Braun V, Zimmermann R, Lahme S (2002) Urinary infection stones. Int J Antimicrob Agents 19(6):488–498CrossRefGoogle Scholar
  11. 11.
    Gault M, Longerich L, Crane G et al (1995) Bacteriology of urinary tract stones. J Urol 153(4):1164–1170CrossRefGoogle Scholar
  12. 12.
    Paonessa JE, Gnessin E, Bhojani N, Williams JC Jr, Lingeman JE (2016) Preoperative bladder urine culture as a predictor of intraoperative stone culture results: clinical implications and relationship to stone composition. J Urol 196(3):769–774CrossRefGoogle Scholar
  13. 13.
    Voilette PD, Denstedt JD (2014) Standardizing the reporting of percutaneous nephrolithotomy complications. Indian J Urol 30(1):84–91CrossRefGoogle Scholar
  14. 14.
    Eswara JR, Lee H, Dretler SP, Sacco D (2013) The effect of delayed percutaneous nephrolithotomy on the risk of bacteremia and sepsis in patients with neuromuscular disorders. World J Urol 31(6):1611–1615CrossRefGoogle Scholar
  15. 15.
    Somani BK, Giusti G, Sun Y et al (2017) Complications associated with ureterorenoscopy (URS) related to treatment of urolithiasis: the Clinical Research Office of Endourological Society URS Global study. World J Urol 35(4):675–681CrossRefGoogle Scholar
  16. 16.
    Fernandez-Rodriguez A, Arrabal-Martin M, Garcia-Ruiz MJ, Arrabal-Polo MA, Pichardo-Pichardo S, Zuluaga-Gomez A The role of thiazides in the prophylaxis of recurrent calcium lithiasis. Actas Urol Espanolas. 30(3):305–309Google Scholar
  17. 17.
    Rule AD, Lieske JC, Li X, Melton LJ 3rd, Krambeck AE, Bergstralh EJ (2014) The ROKS nomogram for predicting a second symptomatic stone episode. J Am Soc Nephrol 25(12):2878–2886CrossRefGoogle Scholar
  18. 18.
    Soygur T, Akbay A, Kupeli S (2002) Effect of potassium citrate therapy on stone recurrence and residual fragments after shockwave lithotripsy in lower caliceal calcium oxalate urolithiasis: a randomized controlled trial. J Endourol 16(3):149–152CrossRefGoogle Scholar
  19. 19.
    Strauss AL, Coe FL, Deutsch L, Parks JH (1982) Factors that predict relapse of calcium nephrolithiasis during treatment: a prospective study. Am J Med 72(1):17–24CrossRefGoogle Scholar
  20. 20.
    Griffith DP (1978) Struvite stones. Kidney Int 13(5):372–382CrossRefGoogle Scholar
  21. 21.
    Patterson DE, Segura JW, LeRoy AJ (1987) Long-term follow-up of patients treated by percutaneous ultrasonic lithotripsy for struvite staghorn calculi. J Endourol 1(3):177–180CrossRefGoogle Scholar
  22. 22.
    Oliver R, Ghosh A, Geraghty R, Moore S, Somani BK (2017) Successful ureteroscopy for kidney stone disease leads to resolution of urinary tract infections: prospective outcomes with a 12-month follow-up. Cent Eur J Urol 70(4):418–423.Google Scholar
  23. 23.
    Walton-Diaz A, Vinay JI, Barahona J, Daels P, González M, Hidalgo JP, Palma C, Díaz P, Domenech A, Valenzuela R, Marchant F (2017) Concordance of renal stone culture: PMUC, RPUC, RSC and post-PCNL sepsis—a non-randomized prospective observation cohort study. Int Urol Nephrol 49(1):31–35CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of UrologyUniversity of Pittsburgh Medical CenterPittsburghUSA

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