Stone removal for treating recurrent urinary tract infections in stone-formers: two birds with one stone or just too soo
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LETTER TO THE EDITOR
Stone removal for treating recurrent urinary tract infections in stone‑formers: two birds with one stone or just too soon to tell? Zhijian Zhao1 · Guohua Zeng1,2 Received: 2 November 2019 / Accepted: 6 November 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Dear editor, With great interest, I read the article by Agarwal et al. [1] in a recent issue of the journal. The authors performed a retrospective study on 46 patients with non‐obstructive metabolic upper tract urinary calculi and recurrent urinary tract infection (rUTI) and concluded that surgical stone removal in these patients resulted in a very high rate (89.1%) of elimination of rUTIs and residual fragments were independently associated with persistent recurrent UTIs. However, I would like to highlight some issues. Their suggestion that “complete stone removal is of paramount importance in treatment of this patient population” arguably paints a prematurely optimistic picture. First, less sample leads to less persuasion. Second, the mean patient age in the study was 63 year. This age group may include individuals with high residual urine, atrophic vaginitis, and bladder bulging although spermicide use and frequency of sexual intercourse are the major risk factors in young women. Third, on the microbiological level, multidrug resistant bacteria are an important factor. Some other theories postulate a change in the glycosaminoglycan barrier of the urothelium that makes an individual more susceptible to enteropathogenic infection. Furthermore, the pathogenic fimbriae of Escherichia are associated with persistent colonization of the urothelium and eliciting an inflammatory This comment refers to the article available online at https://doi. org/10.1007/s00345-019-02977-3. * Guohua Zeng [email protected] 1
Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Urology, Guangdong Key Laboratory of Urology, Guangzhou, China
Present Address: Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Kangda Road 1#, Haizhu District, Guangzhou 510230, Guangdong, China
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response. These bacteria can mature into biofilms in the urothelial barrier to cause recurrence of infections and elude the host immune system. These all contribute to recurrent UTIs, which have been summarized in some literature [2, 3]. The study did not show any information about the kinds of preoperative bacteria and proportion of multidrug resistant bacteria as well as their prognosis respectively. It is possible that the antibiotics administered rather than the surgical stone removal plays a role in resolution of the infection because of antibiotics therapy for at least 1 week pre- and post-operatively. Forth, the relationship between nephrolithiasis and UTI is complex and difficult to analyze on a physio-pathological and clinical point of view. To date, no research has resolved the ‘chicken or the egg dilemma’, i.
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