PD8-05 DOES STONE REMOVAL HELP PATIENTS WITH RECURRENT URINARY TRACT INFECTIONS?

Abstract

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Kidney & Bladder I1 Apr 2015PD8-05 DOES STONE REMOVAL HELP PATIENTS WITH RECURRENT URINARY TRACT INFECTIONS? Mohamed Omar, Hemant Chaparala, Abdullahi Ahmed, and Manoj Monga Mohamed OmarMohamed Omar More articles by this author , Hemant ChaparalaHemant Chaparala More articles by this author , Abdullahi AhmedAbdullahi Ahmed More articles by this author , and Manoj MongaManoj Monga More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.920AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the impact of surgical extraction of non-obstructing asymptomatic stones on recurrent urinary tract infections, and identify predictors of those patients who may be rendered infection-free. METHODS A retrospective study of patients referred with recurrent urinary tract infections who underwent surgical stone extraction with the aim of eradicating the infection. Baseline demographic variables as well as the type of surgery, type of infection, stone composition, readmission rate, and the incidence rate of SIRS were recorded for each patient. Patients were divided into two groups, 1st group with no evidence of recurrence of infection after stone removal and the 2nd with recurrence. Univariate analysis was performed using Wilcoxon's signed-rank test and Fisher's exact test then a Logistic regression was used to test variables during multivariate analysis. RESULTS 120 patients with recurrent urinary tract infections and a non-obstructive renal stone were identified. Surgical management included extracorporeal shockwave lithotripsy (SWL, 32%), ureteroscopy (URS, 7%) and percutaneous nephrolithotomy (PCNL, 61%). 48% (58/120) remained infection-free after surgery with a mean follow-up of 14±3 months, while 52% (62/120) had a recurrence of infection, at a mean time from surgery of 12±2 months. Factors associated with a higher risk of recurrent infections post-procedure included African American race (OR13.7, p=0.009), males with type 2 diabetes (OR 1.73, p=0.0145), and hypertension (OR 2.8, p=.0073). Patients undergoing PCNL were more likely to be rendered infection-free compared to SWL. Infections consisting solely of E.coli were more likely to resolve post-procedure (OR 0.34, p=.0115). In contrast, Enterococcus infections were more likely to persist (OR 2.5, p=.0405). On multiple logistic regression analysis only age, race, HTN and type of surgery were significant. CONCLUSIONS Half of patients with recurrent urinary tract infections and asymptomatic renal calculi may be rendered stone free with stone extraction. Patients with risk factors for recurrent infections after stone extraction should be counseled that stone extraction may not eradicate their infections. PREVALENCE OF INFECTING ORGANISM Infecting organism Group 1(without recurrence) Group 2 (with recurrence) p-value E. coli 31/58 (53%) 31/62 (50%) 0.7056 E. coli (only) 21/58 (36%) 10/62 (16%) 0.0114 K. pneumonia 12/58 (21%) 12/62 (19%) 0.8551 P. mirabilis 6/58 (10%) 7/62 (11%) 0.8677 Urease producing bacteria 9/58 (33%) 23/62 (37%) 0.6184 P. aeruginosa 6/58 (10%) 11/62 (18%) 0.2455 Lactose fermenting bacteria 45/58 (78%) 43/62 (69%) 0.3069 Citrobacter 5/58 (9%) 1/62 (2%) 0.0676 Enterococcus Fecalis 8/58 (14%) 18/62 (29%) 0.0405 © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e191-e192 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Omar More articles by this author Hemant Chaparala More articles by this author Abdullahi Ahmed More articles by this author Manoj Monga More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...