The significance of intraoperative renal pelvic urine and stone cultures for patients at a high risk of post-ureteroscopy systemic inflammatory response syndrome

Abstract

We examined the renal pelvic urine culture (RPUC) and stone culture (SC) during ureteroscopy and evaluated their associations with postoperative systemic inflammatory response syndrome (SIRS). We prospectively collected data of 224 patients who underwent ureteroscopic laser lithotripsy from March 2015 to December 2017. We examined the bladder urine culture pre-operatively. If the patients had positive culture results, we treated them with antibiotics for 5–7 days before surgery based on the sensitivity profile. We collected RPUC and SC samples during surgery. After ureteroscopy, patients were closely monitored for any signs of SIRS. Using a logistic regression model, we analyzed how the clinical factors affected the incidence of SIRS. Pre-operative bladder urine culture (PBUC) was positive in 111 patients (49.6%). Intraoperative RPUC was positive in 43 patients (19.2%), and SC was positive in 34 patients (15.2%). Postoperatively, 23 patients (10.3%) were diagnosed with SIRS. A multivariate analysis revealed that female gender, struvite calculi and positive intraoperative RPUC results were significantly associated with postoperative SIRS. Among the 31 patients who were positive for both PBUC and intraoperative RPUC, the pathogens were not consistent in 11 patients (35.5%). Among the 25 patients who were positive for both PBUC and intraoperative SC, the pathogens were not consistent in 13 patients (52.0%). We recommend collecting RPUC and SC samples during ureteroscopy, especially for patients with high risk factors, including female gender, expected struvite calculi and positive PBUC results.

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Acknowledgements

We greatly appreciate Dr. Sachi Kitayama for her contribution to this study.

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SY: project development, data collection, data analysis, and manuscript writing. RT: project development, data collection, and manuscript editing. YU, YK, YW: data collection. TT: supervision.

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Correspondence to Ryoji Takazawa.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The institutional official ethics committee approved this study (registration number 2015-15). For this type of study, formal consent was not required.

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Yoshida, S., Takazawa, R., Uchida, Y. et al. The significance of intraoperative renal pelvic urine and stone cultures for patients at a high risk of post-ureteroscopy systemic inflammatory response syndrome. Urolithiasis 47, 533–540 (2019). https://doi.org/10.1007/s00240-019-01112-6

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Keywords

  • Ureteroscopy
  • Systemic inflammatory response syndrome
  • Bladder urine culture
  • Renal pelvic urine culture
  • Stone culture