The Role of Stone Culture from Pelvic and Bladder Urine in Predicting Urosepsis Among Patients Undergoing Percutaneous Nephrolithotomy in a Rural Center Catering to A Rural Population
Keywords:
N\AAbstract
Background: Percutaneous nephrolithotomy (PCNL) has evolved significantly since its inception, becoming the preferred treatment for large and complex renal calculi. Despite advancements, postoperative infectious complications like urosepsis remain a major concern. Emerging evidence suggests that intraoperative cultures, particularly from pelvic urine and stone specimens, may predict urosepsis more reliably than preoperative bladder urine cultures.
Objective: This study aimed to evaluate the predictive value of stone culture from pelvic and bladder urine in identifying the risk of urosepsis among patients undergoing PCNL in a rural healthcare setting. Secondary objectives included analyzing sex-based differences and the influence of comorbidities on urosepsis development.
Materials and Methods: In this prospective observational cohort study, 100 patients undergoing PCNL were evaluated over 18 months. Bladder urine, pelvic urine, and stone fragments were cultured intraoperatively. Patients were monitored postoperatively for signs of urosepsis. Data on demographics, comorbidities, and stone characteristics were collected. Statistical analyses included Chi-square tests and logistic regression to determine predictors of urosepsis.
Results: Among 100 patients (mean age 38.4 years; 50 males, 50 females), urosepsis occurred in 22% of those with positive bladder urine cultures and 50% with positive pelvic urine cultures, a statistically significant difference (p=0.0068). Middle-aged females with diabetes mellitus demonstrated the highest incidence of urosepsis in pelvic urine-positive cases. Logistic regression confirmed pelvic urine positivity as a strong independent predictor of postoperative urosepsis.
Conclusion: Pelvic urine cultures provide superior predictive value for postoperative urosepsis compared to bladder urine cultures, particularly in diabetic, middle-aged female patients. Routine intraoperative collection and culture of pelvic urine during PCNL could enable early identification of high-risk individuals, guiding prompt prophylactic and therapeutic interventions to mitigate infectious complications in resource-limited rural healthcare settings.
Downloads
References
Bjazevic J, Nott L, Violette PD, Tailly T, Dion M, Denstedt JD, Razvi H. The evolution of percutaneous nephrolithotomy: Analysis of a single institution experience over 25 years. Can Urol Assoc J. 2019 Oct;13(10):E317-E324. doi: 10.5489/cuaj.5725. PMID: 31364972; PMCID: PMC6788910.
Patel SR, Nakada SY. The modern history and evolution of percutaneous nephrolithotomy. J Endourol. 2015 Feb;29(2):153-7. doi: 10.1089/end.2014.0287. Epub 2014 Sep 17. PMID: 25093997.
Mariappan P, Smith G, Bariol SV, Moussa SA, Tolley DA. Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy: a prospective clinical study. J Urol. 2005 May;173(5):1610-4. doi: 10.1097/01.ju.0000154350.78826.96. PMID: 15821509.
Li Y, Xie L, Liu C. Prediction of systemic inflammatory response syndrome and urosepsis after percutaneous nephrolithotomy by urine culture, stone culture, and renal pelvis urine culture: Systematic review and meta-analysis. Heliyon. 2024 Jun 15;10(13):e33155. doi: 10.1016/j.heliyon.2024.e33155. PMID: 39040347; PMCID: PMC11260937
Li, Yanjun & Xie, Linguo & Liu, Chunyu. (2024). Prediction of systemic inflammatory response syndrome and urosepsis after percutaneous nephrolithotomy by urine culture, stone culture, and renal pelvis urine culture: Systematic review and meta-analysis. Heliyon. 10. e33155. 10.1016/j.heliyon.2024.e33155.
Devraj R, Tanneru K, Reddy B, Amancherla H, Chilumala R. Renal stone culture and sensitivity is a better predictor of potential urosepsis than pelvic or midstream urine culture and sensitivity. J NTR Univ Health Sci. 2016;5(4):261-64
Singh I, Shah S, Gupta S, Singh NP. Efficacy of Intraoperative Renal Stone Culture in Predicting Postpercutaneous Nephrolithotomy Urosepsis/Systemic Inflammatory Response Syndrome: A Prospective Analytical Study with Review of Literature. J Endourol. 2019 Feb;33(2):84-92. doi: 10.1089/end.2018.0842. Epub 2019 Jan 31. PMID: 30585736.
Teh, Khai Yeong; Tham, Teck Meng1. Predictors of post-percutaneous nephrolithotomy sepsis: The Northern Malaysian experience. Urology Annals 13(2):p 156-162, Apr–Jun 2021. | DOI: 10.4103/UA.UA_28_20
Korets R, Graversen JA, Kates M, Mues AC, Gupta M. Post-percutaneous nephrolithotomy systemic inflammatory response: a prospective analysis of preoperative urine, renal pelvic urine and stone cultures. J Urol. 2011 Nov;186(5):1899-903. doi: 10.1016/j.juro.2011.06.064. Epub 2011 Sep 23. PMID: 21944106.
Walton-Diaz A, Vinay JI, Barahona J, Daels P, González M, Hidalgo JP, Palma C, Díaz P, Domenech A, Valenzuela R, Marchant F. Concordance of renal stone culture: PMUC, RPUC, RSC and post-PCNL sepsis-a non-randomized prospective observation cohort study. Int Urol Nephrol. 2017 Jan;49(1):31-35. doi: 10.1007/s11255-016-1457-y. Epub 2016 Nov 15. PMID: 27848063.
Sen V, Bozkurt IH, Aydogdu O, Yonguc T, Yarimoglu S, Sen P, et al. Significance of preoperative neutrophil-lymphocyte count ratio on predicting postoperative sepsis after percutaneous nephrolithotomy. Kaohsiung J Med Sci. (2016) 32:507–13. doi: 10.1016/j.kjms.2016.08.008
Tang Y, Zhang C, Mo C, Gui C, Luo J and Wu R (2021) Predictive Model for Systemic Infection After Percutaneous Nephrolithotomy and Related Factors Analysis. Front. Surg. 8:696463. doi: 10.3389/fsurg.2021.696463
Mishra A, Mittal J, Tripathi S, Paul S. Factors predicting infective complications following percutaneous nephrolithotomy and retrograde intrarenal surgery according to systemic inflammatory response syndrome and quick sequential organ failure assessment: A prospective study. Urol Ann. 2023 Jul-Sep;15(3):295-303. doi: 10.4103/ua.ua_150_22. Epub 2023 Jul 17. PMID: 37664105; PMCID: PMC10471817.
Kapoor R, Vijjan V, Singh K, et al. Predictive value of renal pelvic urine culture compared to midstream urine culture in patients undergoing PCNL. Indian J Urol. 2022;38(4):321-326. doi:10.4103/iju.IJU_146_22.
Ahmed ME, Yassin AA, Mahmoud A. Predicting postoperative infections following percutaneous nephrolithotomy: The role of intraoperative culture specimens. Arab J Urol. 2021;19(1):45-51. doi:10.1080/2090598X.2021.1882157.
Zhang X, Zhang J, Sun Y, et al. Risk factors and microbiological profiles associated with sepsis after PCNL: A multicenter prospective study. BMC Urol. 2023;23:72. doi:10.1186/s12894-023-01245-6.
Chen Z, Fan J, Fang Z, et al. Positive stone culture predicts postoperative infectious complications better than midstream urine culture in PCNL. Urol Int. 2022;106(3):289-295. doi:10.1159/000521234.
Alvarez-Maestro M, Hevia V, Sanz-Pérez E, et al. Importance of renal pelvic urine culture for predicting infectious complications after PCNL: A prospective study. World J Urol. 2021;39(9):3477-3483. doi:10.1007/s00345-021-03553-8.
Barros FP, Torricelli FCM, Rocha BA, et al. Prospective evaluation of infection predictors in percutaneous nephrolithotomy: Role of stone culture. Int Braz J Urol. 2022;48(5):730-737. doi:10.1590/S1677-5538.IBJU.2022.0136.
Huang J, Zhang W, Yang Y, et al. Clinical value of intraoperative renal stone cultures in predicting postoperative sepsis following PCNL. Medicine (Baltimore). 2023;102(8):e32904. doi:10.1097/MD.0000000000032904.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
