Renal Pelvis Urine Sampling in Patients with Obstructed, Infected Ureterolithiasis: A Retrospective Quality Improvement Initiative.

IF 2.9 2区 医学 Q1 UROLOGY & NEPHROLOGY
Journal of endourology Pub Date : 2025-01-01 Epub Date: 2024-12-05 DOI:10.1089/end.2024.0179
Majid Mirzazadeh, Raymond Xu, Collette O'Connor, Parth U Thakker
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Abstract

Purpose: Patients who present with urinary tract infections secondary to obstructing stones occasionally fail to improve on treatment based on midstream urine culture (MUSCx). Varying microbiomes between the bladder and the renal pelvis may account for this. In this study, we sought to investigate the utility of obtaining a renal pelvis urine culture (RPUCx) at the time of stenting to guide antibiotic treatment prior to definitive stone operation. Materials and Methods: RPUCx was obtained in 257 patients presenting with obstructive ureteral stones undergoing emergent stenting. Concordance rates of RPUCx to MUSCx and blood cultures were examined. Operative time and infectious complication rates after definitive stone management between the two groups were studied. A comparison of those who received an intraoperative RPUCx with those who did not was carried out. Results and Conclusions: RPUCx was obtained in patients undergoing emergent stenting from 2018 to -2021; 31% (52/168) of patients had pathogens in the renal pelvis that were absent in the MUSCx. RPUCx had a greater concordance rate with blood culture results compared with MUSCx (95% vs 50%). Drawing RPUCx intraoperatively did not significantly change operative time (15.9 vs 13.6 minutes, p = 0.15). Treatment tailored to RPUCx resulted in lower rates of post-stone management complications (odds ratio 0.26, 95% confidence interval = 0.08-0.83; p = 0.01). RPUCx at the time of stenting can guide treatment and decrease post-treatment complications without additional operative time, confirming utility in the treatment of patients with infection secondary to obstructing stones.

梗阻性感染输尿管结石患者的肾盂尿液取样:回顾性质量改进倡议。
目的:梗阻结石继发尿路感染的患者偶尔不能通过中游尿培养(MUSCx)治疗得到改善。膀胱和肾盂之间不同的微生物群可能解释了这一点。在这项研究中,我们试图探讨在支架植入时进行肾盂尿培养(rucx)以指导最终结石手术前的抗生素治疗的效用。材料与方法:对257例输尿管梗阻性结石行紧急支架置入的患者进行rucx采集。检测rucx与MUSCx及血培养的符合率。比较两组结石治疗后的手术时间和感染并发症发生率。对术中接受rucx的患者与未接受rucx的患者进行比较。结果与结论:2018 -2021年急诊支架植入术患者获得rucx;31%(52/168)的患者肾盂内存在MUSCx中未见的病原体。与MUSCx相比,rucx与血培养结果的符合率更高(95% vs 50%)。术中拔除rucx对手术时间无显著影响(15.9 vs 13.6分钟,p = 0.15)。针对rucx的治疗导致较低的结石后并发症发生率(优势比0.26,95%可信区间= 0.08-0.83;P = 0.01)。支架置入时的rucx可以指导治疗,减少治疗后并发症,无需额外的手术时间,证实了其在治疗梗阻性结石继发感染患者中的实用性。
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来源期刊
Journal of endourology
Journal of endourology 医学-泌尿学与肾脏学
CiteScore
5.50
自引率
14.80%
发文量
254
审稿时长
1 months
期刊介绍: Journal of Endourology, JE Case Reports, and Videourology are the leading peer-reviewed journal, case reports publication, and innovative videojournal companion covering all aspects of minimally invasive urology research, applications, and clinical outcomes. The leading journal of minimally invasive urology for over 30 years, Journal of Endourology is the essential publication for practicing surgeons who want to keep up with the latest surgical technologies in endoscopic, laparoscopic, robotic, and image-guided procedures as they apply to benign and malignant diseases of the genitourinary tract. This flagship journal includes the companion videojournal Videourology™ with every subscription. While Journal of Endourology remains focused on publishing rigorously peer reviewed articles, Videourology accepts original videos containing material that has not been reported elsewhere, except in the form of an abstract or a conference presentation. Journal of Endourology coverage includes: The latest laparoscopic, robotic, endoscopic, and image-guided techniques for treating both benign and malignant conditions Pioneering research articles Controversial cases in endourology Techniques in endourology with accompanying videos Reviews and epochs in endourology Endourology survey section of endourology relevant manuscripts published in other journals.
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