10,15,16 The spectrum of bacteria differs somewhat among pure metabolic stones, pure infection stones, and mixed metabolic/infection stones (Table 3). Table 2 Upper Tract Surgical Stone Series and Stone Culture Results Since 1980 Table 3 Upper Tract Surgical Stone Series Reporting Results of Both Metabolic and Infection Stone Cultures Since 1980 Conclusions
Our case was certainly unique in that it represents the most bacterial species ever isolated Inhibitors,research,lifescience,medical from a surgically removed upper urinary tract stone. The role of stone culture is not clearly defined; however, it may be advisable during removal of large volume upper tract stones as it may permit more targeted antimicrobial therapy and perhaps avert some of the consequences of SIRS or sepsis. This will need to be verified with a randomized, controlled Inhibitors,research,lifescience,medical study, which to date has not been done. In addition, certain patients undergoing surgical removal of smaller upper tract stones may benefit from such testing, and the profiles of such patients will need to be determined. Main Points Despite the use of culture-specific or broad-spectrum antibiotic therapy prior to surgical removal of upper tract nephrolithiasis, certain patients still develop postoperative sepsis.
Some have Selleck Bortezomib reported that preoperative Inhibitors,research,lifescience,medical voided urine cultures from these patients may not be reflective of the bacterial environment within the stone that is to be treated. The development of a urinary tract infection is Inhibitors,research,lifescience,medical a common postoperative complication associated with removal of upper urinary tract stones; one-third of patients undergoing percutaneous nephrostolithotomy
experience this occurrence, which places patients at risk for developing sepsis and systemic inflammatory response syndrome, which can be fatal. Inhibitors,research,lifescience,medical Prescribing antimicrobial therapy that will eradicate the organism in the urine and provide broad-spectrum coverage for the potentially different bacteria harbored within the stone is desired. GBA3 In addition, performing a stone culture may help to identify organisms that are not covered by initial antibiotic therapy, providing an opportunity to institute earlier targeted therapy. Footnotes The authors report no real or apparent conflicts of interest.
Over 2300 posters, abstracts, and videos were presented at the annual meeting of the American Urological Association (AUA), held this year in Atlanta, Georgia, May 19–23, 2012. The editors of Reviews in Urology have culled an enormous volume of information from this premier source and present those findings that are the most relevant to the practicing urologist.