Related Experiment Video
Updated: Mar 12, 2026
Author Spotlight: Developing a Bedside Protocol for Kidney and Genitourinary Ultrasonography
Published on: June 21, 2024
Concordance of renal stone culture: PMUC, RPUC, RSC and post-PCNL sepsis-a non-randomized prospective observation
Annerleim Walton-Diaz1, José Ignacio Vinay1, Jaime Barahona1
1Servicio de Urología, Hospital Clínico Universidad de Chile, Santos Dumont 999, 8380456, Independencia, Santiago, Chile.
Introduction:
Between 5 and 10% of patients undergoing percutaneous nephrolithotomy (PCNL) develop postoperative sepsis 1, 2. Strategies to prevent infectious complications are based on information provided by preoperative midstream urine cultures (PMUC). The aim of this study is to evaluate the concordance of the microbiologic findings of PMUC, cultures of the renal stone (RSC) and urine obtained directly from the renal pelvis (RPUC) in patients undergoing PCNL.
Materials And Methods:
This is a multicenter prospective study. The study included all patients who underwent PCNL from May 2013 to July 2015 in three academic hospitals. All patients underwent a PMUC. Samples for RPUC were obtained by renal puncture for PCNL. Stone fragments extracted during the procedure were sent for culture (RSC). Clinical variables, stone configuration, burden and microbiology reports of cultures were recorded. We analyzed concordance between cultures and association with infectious complications.
Results:
One hundred and twenty-two patients underwent PCNL. Twenty-four percent had positive culture, 3.2% (4/122) PMUC, 14.7% (18/122) RPUC and 13.9% (17/122) RSC. Positive PMUC demonstrated multidrug-susceptible Escherichia coli and Staphylococcus aureus, while RPUC showed multidrug-resistant pathogens and/or fungus. Seven patients (5.7%) developed postoperative infectious complications prior to discharge. There was a weak correlation between PMUC and intraoperative urine cultures (RPUC and RSC). Concordance rate between RPUC and RSC was 83.3%. The most common isolated pathogens were multidrug-resistant bacteria or fungus.
Conclusions:
PMUC did not reflect the microbiological environment found in stones and urine directly obtained from the renal pelvis. Patients with postoperative infectious complications had negative PMUC with positive RPUC or RSC. RPUC and RSC can help guide prompt and appropriate antibiotic treatment for patients who develop postoperative infectious complications after PCNL.
Insights
Preoperative urine cultures do not accurately predict infection during percutaneous nephrolithotomy (PCNL). Renal pelvis urine and stone cultures better identify pathogens, guiding appropriate antibiotic treatment for postoperative infections after PCNL.
Area of Science:
- Urology
- Infectious Diseases
- Microbiology
Background:
- Percutaneous nephrolithotomy (PCNL) carries a 5-10% risk of postoperative sepsis.
- Current infection prevention relies on preoperative midstream urine cultures (PMUC).
- Limited data exists on the concordance of PMUC with intraoperative cultures.
Purpose of the Study:
- To evaluate the concordance of microbiological findings between PMUC, renal stone cultures (RSC), and renal pelvis urine cultures (RPUC) in PCNL patients.
- To determine the utility of these cultures in predicting infectious complications.
Main Methods:
- Multicenter prospective study of 122 patients undergoing PCNL.
- Collected PMUC, RPUC, and RSC samples.
- Analyzed culture concordance and association with postoperative infectious complications.
Main Results:
- Positive cultures: 24% overall; PMUC 3.2%, RPUC 14.7%, RSC 13.9%.
- PMUC identified susceptible E. coli/S. aureus; RPUC/RSC revealed multidrug-resistant pathogens/fungi.
- Seven patients (5.7%) developed infections; 5 had negative PMUC but positive RPUC/RSC.
- Weak correlation between PMUC and intraoperative cultures; RPUC-RSC concordance was 83.3%.
Conclusions:
- PMUC is unreliable for predicting the intraoperative microbiological environment in PCNL.
- RPUC and RSC are more effective in identifying causative pathogens, including multidrug-resistant organisms.
- Positive RPUC/RSC with negative PMUC indicates a risk for infectious complications, guiding targeted antibiotic therapy.
More Related Videos
07:03Standardized Colon Ascendens Stent Peritonitis in Rats - a Simple, Feasible Animal Model to Induce Septic Acute Kidney Injury
Published on: February 15, 2022
10:38Observational Study Protocol for Repeated Clinical Examination and Critical Care Ultrasonography Within the Simple Intensive Care Studies
Published on: January 16, 2019
Related Concept Videos
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:26Urine Studies II: Urine Culture and Sensitivity Test
01:30Urinary Tract Calculi III: Medical Management
01:25Urinary Tract Calculi VI: Surgical Management
01:26Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care