Sepsis complicated by brain abscess following ESWL of a caliceal kidney stone: a case report

Abstract

A 47-year old, Caucasian man underwent extracorporeal shock wave lithotripsy (ESWL) of a 14mm calcium stone in the right renal pelvis, without urinary tract obstruction or sepsis. 24 hours after ESWL septic shock occurred and the patient was admitted to the Intensive Care Unit (ICU). Escherichia coli emerged from the blood and urine culture. The patient developed acute renal failure and it was necessary to start a continuous renal replacement therapy (CRRT). Infection was successfully treated, patient recovered renal function and an improvement of general condition occurred. The patient was then discharged but three day later the patient returned to the hospital to seek treatment for left facial hemiparesis and hypotonia of his left arm. The brain computed tomography showed a wide abscess (55×75mm) in the frontal right parietal region. A neurosurgical intervention was then performed and the culture of the drained material resulted positive for Escherichia coli. The guidelines of European and American Associations of Urology do not suggest a prophylactic antibiotic therapy for pre-ESWL (except in the presence of risk factors). The serious complication that occurred in the described low risk patient raises the question of whether routine culture and/or antibiotic prophylaxis, is appropriate.

Unilateral endogenous Candida endophthalmitis after extracorporeal shock wave lithotripsy for a renal stone in an immunocompetent woman: a case report

“…Administrations of prophylactic antibiotics for patients who undergo ESWL are controversial according to previous studies. In several studies, pre-operative antibiotics are recommended in patients with high-risk factors such as having instrument or stent at the time of ESWL, positive urine culture, infected and stag-horn stones, and recurrent UTI [7–9]. The importance of prophylactics antifungal administration for patients who undergo ESWL has not been investigated so far.…”

Efficacies of Various Surgical Regimens in the Treatment of Renal Calculi Patients: a Network Meta-Analysis in 25 Enrolled Controlled Clinical Trials

“…Microperc has been found to be safe and effective in removing small renal calculi in the adult and pediatric populations with a high stone-free rate and lower complication rate [8]. Despite all the new approaches, shock wave lithotripsy (SWL) remains the first line treatment modality that is widely used for renal, ureteral and intermediate-size renal calculi [9][10][11]. Its success rates from contemporary series vary from 60 to 90% [12].…”