Does treatment of non-obstructing nephrolithiasis reduce recurrent urinary tract infections? A prospective,...

Existing studies link kidney stone treatment to reduced recurrent urinary tract infections (UTIs); however, these studies are limited by their retrospective design and/or lack of comparison group. The present study assesses a prospective, observational cohort of patients with recurrent UTIs who selected observation or intervention for management of their non-obstructing kidney stones to assess for impact on UTI recurrence.

From 2020-2025, patients with non-obstructing kidney stones and recurrent UTIs were prospectively enrolled at four centers. After shared decision-making, participants underwent observation or surgical intervention. The primary outcome was UTI recurrence at 12 months post-enrollment, defined as presence of urinary tract symptoms with positive urine culture. The study was powered to detect a 50% reduction in the rate of UTI recurrence between the groups at 12 months.

Among 94 patients recruited, followup data at 12 months was available for 21 observation and 46 intervention patients. There were more staghorn stones in the intervention group (15.2% vs. 0%), and the median stone size was larger (13.5 vs. 6 mm). At 12 months, 81% (n=17) in the observation group and 54% (n=25) in the intervention group had a symptomatic UTI recurrence (p=0.06, non-significant). The subgroup (n=17) of stone-free intervention patients had fewer UTI recurrences compared to the observation group (odds ratio 0.12, 95% confidence interval 0.02-0.66). Causation cannot be confirmed due to the observational nature of the study.

For patients with recurrent UTIs and stones, surgical intervention is not associated with decreased risk of UTI recurrence at 12 months overall; however, patients who were stone-free after intervention had significantly fewer UTI recurrences on subgroup analysis.