Even appropriately treated preoperative urinary infections may not prevent infected urine at percutaneous nephrolithotomy. Renal pelvic urine and stone cultures may be the only way to identify the causative organism and direct antimicrobial therapy. We recommend collecting pelvic urine and stone cultures to identify the offending organism in patients at risk for sepsis, particularly those with a large stone burden requiring multiple access tracts.
AML is a renal tumor that usually exhibits a benign course. Surgical removal and embolization are the standard invasive treatment modalities. AS for AMLs is associated with a slow and consistent growth rate (0.088 cm/year), typically has minimal morbidity, and is a reasonable option in selected patients. Symptomatic presentation and size (> 3 cm) are not predictive for necessitating an invasive procedure.
Absent surgical decompression is associated with higher odds of mortality in patients with sepsis and ureteral calculi. Further research to determine predictors of surgical decompression is necessary to ensure that all patients have access to this life saving therapy.
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