Does treatment of non-obstructing nephrolithiasis reduce recurrent urinary tract infections? A prospective, observational trial from the EDGE consortium.

Abstract

Introduction: Existing studies link kidney stone treatment to reduced recurrent urinary tract infections (UTIs); however, these studies are limited by their retrospective design and/or lack of comparison group. The present study assesses a prospective, observational cohort of patients with recurrent UTIs who selected observation or intervention for management of their non-obstructing kidney stones to assess for impact on UTI recurrence.

Methods: From 2020-2025, patients with non-obstructing kidney stones and recurrent UTIs were prospectively enrolled at four centers. After shared decision-making, participants underwent observation or surgical intervention. The primary outcome was UTI recurrence at 12 months post-enrollment, defined as presence of urinary tract symptoms with positive urine culture. The study was powered to detect a 50% reduction in the rate of UTI recurrence between the groups at 12 months.

Results: Among 94 patients recruited, followup data at 12 months was available for 21 observation and 46 intervention patients. There were more staghorn stones in the intervention group (15.2% vs. 0%), and the median stone size was larger (13.5 vs. 6 mm). At 12 months, 81% (n=17) in the observation group and 54% (n=25) in the intervention group had a symptomatic UTI recurrence (p=0.06, non-significant). The subgroup (n=17) of stone-free intervention patients had fewer UTI recurrences compared to the observation group (odds ratio 0.12, 95% confidence interval 0.02-0.66). Causation cannot be confirmed due to the observational nature of the study.

Conclusions: For patients with recurrent UTIs and stones, surgical intervention is not associated with decreased risk of UTI recurrence at 12 months overall; however, patients who were stone-free after intervention had significantly fewer UTI recurrences on subgroup analysis.