Endoscopic stone surgery: minimizing the risk of post-operative sepsis

Urosepsis from manipulation of the urinary tract during stone surgery can be catastrophic despite antibiotic prophylaxis and sterile pre-operative urine. We have reviewed recent literature with regards to pathogenesis, predictors of infected stones and prevention of urosepsis.

Bladder urine culture has been found to correlate poorly with infection in the upper urinary tract, defined by either stone or pelvic urine culture. This specimen, which has been the cornerstone in pre-operative preparation of patients, does not predict urosepsis. Authors recommending routine stone culture found that the presence of infected stones is highly predictive of potential sepsis. Terminology for systemic infection has been standardized and used in recent literature to define urosepsis.

Recent studies have recommended changes in the approach to the peri-operative management of stone surgery. Predictors of potential sepsis have also been identified.