Renal Pelvis Urine Sampling in Patients with Obstructed, Infected Ureterolithiasis: A Retrospective Quality...

Area of Science:

• Urology
• Infectious Diseases
• Medical Microbiology

Background:

• Urinary tract infections (UTIs) secondary to obstructing stones can be challenging to treat.
• Standard midstream urine cultures (MUSCx) may not accurately reflect the infection in the renal pelvis.
• Discrepancies in microbial populations between the bladder and renal pelvis can lead to treatment failure.

Purpose of the Study:

• To evaluate the clinical utility of renal pelvis urine culture (RPUCx) obtained during stenting.
• To determine if RPUCx can improve antibiotic selection and reduce infectious complications.
• To compare RPUCx with MUSCx and blood cultures for accuracy in identifying pathogens.

Main Methods:

• A prospective study involving 257 patients with obstructive ureteral stones undergoing emergent stenting.
• RPUCx was collected intraoperatively and compared with concurrent MUSCx and blood cultures.
• Infectious complication rates and operative times were analyzed between groups receiving RPUCx-guided treatment and those not.

Main Results:

• 31% of patients had pathogens in the renal pelvis not detected by MUSCx.
• RPUCx showed higher concordance with blood culture results (95%) compared to MUSCx (50%).
• Treatment guided by RPUCx significantly reduced post-stone management complications (OR 0.26, p=0.01) without increasing operative time.

Conclusions:

• Renal pelvis urine culture (RPUCx) is a valuable tool for guiding antibiotic therapy in patients with obstructive stones and suspected UTIs.
• Utilizing RPUCx can lead to more effective treatment and a significant decrease in post-treatment infectious complications.
• Intraoperative RPUCx collection is feasible and does not prolong operative time, offering a clear benefit in patient management.