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Perioperative antibiotic prophylaxis for stone therapy.

Marco J Schnabel1, Florian M E Wagenlehner2, Laila Schneidewind3

  • 1Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg.

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|January 23, 2019
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Antibiotic prophylaxis for urolithiasis therapy should be risk-adapted. Single-dose antibiotics suffice for percutaneous nephrolithotomy (PCNL) and ureterorenoscopy (URS), while shock-wave lithotripsy (SWL) requires none.

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Area of Science:

  • Urology
  • Infectious Disease
  • Pharmacology

Background:

  • Antibiotic prophylaxis is crucial in urolithiasis treatment to prevent infections.
  • Recent literature is limited, necessitating a review of current practices.

Purpose of the Study:

  • To provide an overview of state-of-the-art antibiotic prophylaxis in urolithiasis therapy.
  • To focus on recent publications and guideline recommendations.

Main Methods:

  • Review of recent high-quality publications on antibiotic prophylaxis in urolithiasis.
  • Analysis of inflammatory markers for predicting postoperative complications.
  • Evaluation of antibiotic regimens for different urolithiasis treatment modalities.

Main Results:

  • Preoperative inflammatory markers (CRP, ESR) may predict SIRS post-PCNL.
  • WBC count is not predictive for UTI in acute renal colic.
  • Single-dose antibiotics are effective for PCNL and URS, comparable to prolonged use.
  • Antibiotic prophylaxis is unnecessary for SWL in low-risk patients.

Conclusions:

  • Current evidence supports risk-adapted, minimal antibiotic use in urolithiasis.
  • Guidelines from AUA and EAU recommend single-dose prophylaxis for low-risk PCNL and URS.
  • No antibiotic prophylaxis is needed for SWL in low-risk patients.