A comparison of pre-operative urine culture with intra-operative stone culture: a prospective observational study

Abstract

Background It is well known that urinary calculi are associated with urinary tract infections. Post-operative sepsis is one of the major complications after various endourological procedures for stone surgeries. These episodes of sepsis occur even in negative urine cultures. Stones have been found to harbour bacteria which on fragmentation causes bacteremia and sepsis. Thus, usual practice of pre-operative urine culture cannot truly predict the occurrence of post-operative sepsis. It also seems logical that intra-operative stone cultures could guide us for early management of such episodes of sepsis. The purpose of this study was to determine if there exists any association between urine and stone cultures in patients undergoing endourological stone surgeries. Methods This is a prospective comparative observational study, in patients undergoing endoscopic procedures for calculus in urinary tract. Mid-stream urine cultures were obtained 3 to 5 days prior to surgery and crushed stone culture during the surgery. Comparison was then made between the two with respect to positivity, location of calculus and bacterial flora. Results A total of 122 cases of urolithiasis were included, in which 30 (24.59%) cases had a positive urine culture, whereas 62 (50.82%) patients were positive for stone culture. This significant difference was maintained only in renal stones on subset analysis (p value < 0.0001). Both cultures were positive in only 15% of cases, and bacteriological analysis showed same organism in just 6.5% of cases. In our study, sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of urine culture against the stone culture were 29.03%, 80%, 60%, 52.17% and 54.09%. Conclusion The results of our study suggests that pre-operative urine cultures have a poor predictive value and accuracy for infective organism in the renal stone. Therefore, stone culture should be included in routine protocols during renal endourologic surgery for stones.

Postoperative Urinary Tract Calculi Culture – Is it necessary in Negative Urine Culture Patients?

“…In recent years, multiple studies arise to assess the value of calculi culture, most studies promote the usage of calculi culture as a routine examination (Songra et al, 2015;Eswara et al, 2013;Gupta et al, 2020;Ashra Mahabadi & Kumar, 2022). We highly considered the clinical importance of calculi culture in patients with negative preoperative urine culture, as the result enabled the clinician to manage patients with precision.…”

“…Postoperative calculi culture is not routinely performed in stone surgery cases, previous studies revealed the diverse result. Five studies encourage routine calculi culture examination (Songra et al, 2015;Martov et al, 2014;Gupta et al, 2020;Ashra Mahabani & Kumar, 2022), but two studies suggest the opposite (Osman et al, 2016;Elshal et al, 2014). Songra et al (2015), and Gupta et al (2020) showed the relevancy of calculi culture in urological procedures, but the included cases were all preoperative urine culture status, positive and negative.…”

“…Five studies encourage routine calculi culture examination (Songra et al, 2015;Martov et al, 2014;Gupta et al, 2020;Ashra Mahabani & Kumar, 2022), but two studies suggest the opposite (Osman et al, 2016;Elshal et al, 2014). Songra et al (2015), and Gupta et al (2020) showed the relevancy of calculi culture in urological procedures, but the included cases were all preoperative urine culture status, positive and negative. Positive urine cultures will be managed with relevant antibiotics, none of those studies emphasized the importance of calculi culture in previously negative urine cultures.…”

A comparative study of midstream urine culture and stone culture in patients undergoing ureteroscopic stone removal

“…The bacterial ecology of the stone could thus be employed as a predictor of post-operative indicators of urosepsis. Stone culture is not common in endourologic surgeries, and pre-operative urine cultures have been relied on to treat post-operative infections and sepsis (7).…”

Perbandingan Mikroorganisme Pada Kultur Urin Pre-Operasi Dan Kultur Batu Pasca Operasi Pada Pasien Batu Saluran Kemih

“…Pemeriksaan ini merupakan salah satu pemeriksaan rutin sebelum dilakukannya operasi pada pasien untuk mengetahui apakah terdapat bakteri pada urine pasien, jenis bakteri dan resistensinya terhadap antibiotik. 5,[8][9][10] Teori pembentukan batu saluran kemih yang paling banyak dipakai adalah teori supersaturasi. Supersaturasi dapat terjadi jika substansi yang penyusun batu terdapat dalam jumah yang besar dalam urin.…”