Table 2.
Outcomes of intervention and resolution of UTI
| Author, year | Study, (country) | Population | Age (median); males; females | Stone composition | Pre-operative UC + | Pre-operative recurrent UTI | Procedures (n, type) | SFR | UAS | Length of stay | Complications, n, (type) | Follow up (FU) | Outcomes |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Hugosson et al. (1989) [16] | Retrospective (Sweden) | 43 patients with bacteriuria and renal stones | 58 (22–83); 14; 29 |
14 struvite/carbonate apatite; 9 CaOx/CaP |
E. coli 18; Proteus 11; Klebsiella 2; Enterobacter cloacae 1; Pseudomonas 1; Gardnerella vaginalis 1; S. saprophiticus 1; S. epidermidis 2; E. faecalis 3; Streptococcus 1; Multiple 2 |
Bacteriuria: 15 for > 10 years; 11 for 5–10 years; 15 for 2–5 years; 2 for < 2 years |
23 (15 PCNL; 4 open nephrolithotomy; 1 TUR extraction; 2 nephrectomies; 1 upper pole resection) | NA | NA | NA | NA | 23 months (10–48) | 87% free from infection at FU; 13% persistent bacteriuria after surgery (residual fragments) |
| Oliver et al. (2017) [25•] | Prospective, cohort study (UK) | 103 patients with rUTI or pre-operative UC + who underwent URS | 60 (21–89); 37; 66 |
63 CaOx (61.2%); 17 struvite (16.5%); |
81 (78.6%) UC + ; E. coli 31 (38.3%); Enterococcus spp 10 (2.3%); Coliforms 8 (9.8%); Yeast 7 (8.6%); Proteus 4 (4.9%); Pseudomonas 3 (3.7%); Staphylococcus 2 (2.5%); Klebsiella 2 (2.5%); multiple 14 (17.3%) |
22 (21.4%) | 115 URS (94 unilateral; 9 bilateral; 12 2–staged) | 96% | 42 (41%) | 1.4 ± 3.8 days |
13 (12.6%) UTI (n = 3), sepsis (n = 7), stent pain (n = 3) |
3, 6, 12 months |
3 m: SFR 96%, IFR 88%; 6 m: SFR 90%, IFR 86%; 12 m: SFR 82%, IFR 71% (p < 0.001) |
| Agarwal et al. (2020) [26•] | Retrospective (USA) | 46 patients with rUTI who underwent a procedure for urolithiasis | 63.7 (49.2–73.4); 4; 42 |
CaOx monohydrate 15; CaOx dihydrate 3; apatite 11; brushite 2; uric acid 5; mixed 14 |
E. coli 17 (37%), Enterococcus spp 8 (17%), Klebsiella 6 (13%) | ≥ 3 UTI in 12 months, with symptoms and UC + | 43% URS; 57% PCNL ± URS | 63% URS; 65% PCNL; | NA | NA | 3 (2 SIRS/sepsis, 1 readmission) | 2.9 years (IQR 2.0–4.3) |
89% rUTI-free; average 3.1 UTI before surgery vs 0.5 after surgery (p < 0.001); residual stone associated with rUTI (p = 0.046) |
| Omar et al. (2015) [27•] | Retrospective (USA) | 120 patients with rUTI who underwent surgical stone extraction | 59.5 ± 18.1; 38; 82 | CaOx 29; CaP 49; struvite 6; uric acid 7; mixed 2 | E. coli 62; Klebsiella 24; Proteus 13; Pseudomonas 17; Citrobacter 6; Enterococcus 26 | 3 or more UTIs per year, or 2 or more in 6 months | URS 8 (6.6%); PCNL 73 (60.8%); ESWL 39 (32.5%) | NA | NA | 2.95 ± 3.9 days | 16 (13.3%) SIRS | 14 ± 3 months |
58 pts (48%) infection-free after surgery 62 pts (52%) rUTI |
CaOx calcium oxalate, CaP calcium phosphate, ESWL extracorporeal shock wave lithotripsy, IFR infection-free rate, NA not available, PCNL percutaneous nephrolithotomy, rUTI recurrent urinary tract infections, SIRS systemic inflammatory response syndrome, SFR stone-free rate, UC + positive urine culture, TUR trans-urethral resection, URS ureteroscopy, UAS ureteral access sheath