Comparative Study of Preoperative Urine Culture and Intraoperative Stone Culture in Predicting Postoperative...

Postoperative urosepsis after endourological treatments is a life-threatening condition, especially when the individual has urolithiasis. Although preoperative urine culture is a routine tool for guiding antibiotic prophylaxis, it frequently fails to identify bacteria embedded in urinary stones, which may lead to undiagnosed postoperative morbidity. Hence, this study aimed to evaluate the association between preoperative urine culture and intraoperative stone culture and determine their predictive value for postoperative infectious complications in patients undergoing endourological procedures.

This prospective observational study was conducted among 125 adult patients undergoing surgical treatment of urolithiasis in a tertiary care facility between June 2023 and December 2024. Urine culture collected before surgery and stone for stone culture obtained during surgery were tested for microbial growth and antibiotic sensitivity patterns. C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), total leukocyte count (TLC), and hospital stay were measured as postoperative parameters in addition to culture results.

Culture was positive in the urine of 27 (21.6%) patients, while stone culture was positive in 61 (48.8%) cases. The most common organisms were Escherichia coli (E. coli), Pseudomonas, and Klebsiella. A non-significant correlation existed between urine and stone culture (p > 0.05). Patients with positive stone culture had markedly elevated postoperative inflammatory markers and higher morbidity rates, irrespective of urine culture results.

Preoperative urine culture alone is an unreliable predictor of postoperative infectious complications. Intraoperative stone culture is a superior tool for identifying occult pathogens and predicting morbidity. Incorporating routine stone culture into urolithiasis management can enable timely, targeted antibiotic therapy and reduce postoperative morbidity.