Treatment of non-obstructive, non-struvite urolithiasis is effective in treatment of recurrent urinary tract infections
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ORIGINAL ARTICLE
Treatment of non‑obstructive, non‑struvite urolithiasis is effective in treatment of recurrent urinary tract infections Deepak K. Agarwal1 · Amy E. Krambeck2 · Vidit Sharma1 · Francisco J. Maldonado1 · Mary E. Westerman1 · John J. Knoedler3 · Marcelino E. Rivera1,4 Received: 28 January 2019 / Accepted: 4 October 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Purpose Abstract To determine if treatment of non-obstructing urolithiasis is effective in management of recurrent UTI. Materials and methods A retrospective review was performed of patients undergoing elective management of non-struvite upper tract urinary calculi with recurrent UTI from 2009 to 2016. Recurrent UTI was defined at ≥ 3 UTI in 12 months, with symptoms and documented urine culture. Preoperative CT was performed in all patients to determine stone burden. All patients had postoperative imaging and ≥ 12 months of follow-up. Pre- and postoperative variables were between patients who had recurrent UTI after treatment versus those who did not. Results 46 patients met inclusion criteria. 42 (91.3%) were female. Median age was 63.7 years (IQR 49.1, 73.4) and median total stone burden was 20 mm (IQR 14–35). Within the cohort, 20 (43.5%) underwent ureteroscopy only, 26 (56.5%) underwent PCNL ± URS, and none underwent ESWL. Median postoperative follow-up was 2.9 years (IQR 2.0, 4.3). Only five patients (10.9%) had recurrent UTI after treatment. 80% were with the preoperative pathogen. The presence of residual stone was an independent risk factor for recurrent UTI after treatment (p 30 days after the stone procedure at a median time of 12.3 months (IQR 5.2–27.8), and no factors were significantly different between those with and without Table 2 Univariate analysis of postoperative recurrent vs no recurrent UTI
sporadic UTIs. 89% of the cohort was free of recurrent UTIs postoperatively. In the group of five patients with recurrent UTIs, four occurred within 12 months and one occurred > 12 months. Four of the five had recurrent UTIs with the same pathogen identified preoperatively. On average, patients experienced on average 3.1 UTIs in the year prior to surgical intervention and only 0.5 UTI in the following year, with a statistically significant difference on paired t test analysis of p 1 cm. Not all patients had same imaging follow-up (CT, KUB and/or US) or time to follow-up, which may impact the true stone free rate. Due to the high rate of cure, our group of patients with postoperative recurrent UTI was small. This was a single center study, however a single surgeon performed all ureteroscopies and PCNL in similar fashion. There was not a control group to compare continued conservative, symptomatic based treatment of recurrent UTI, however given the stone parameters in the patient population a matched control group of observation would be difficult given stone sizes. We did attempt to control for this by comparing number preoperative versus postoperative UTIs in paired fashion as a surrogate for a control
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