Contemporary Management of Struvite Stones Using Combined Endourological and Medical Treatment: Predictors of Unfavorable Clinical Outcome

Iqbal, Muhammad Waqas; Youssef, Ramy; Neisius, Andreas; Kuntz, Nicholas; Hanna, Jonathan; Ferrandino, Michael N.; Preminger, Glenn M.; Lipkin, Michael

doi:10.1089/end.2013-0257.ecc13

Cited by 5 publications

(6 citation statements)

References 4 publications

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“…The recommendations made by current guidelines are based on retrospective analyses. 6,[9][10][11][12] A patient collective from 1982 evaluated 99 patients with staghorn stones and concluded that Staghorn calculi should receive an adjunctive long-term medical treatment. 13 Streem et al published a retrospective analysis of 100 preoperative patients undergoing combination PNL and shock wave lithotripsy and if necessary repeat PNL due to extensive kidney stones.…”

Section: Discussionmentioning

confidence: 99%

Prospective randomized trial of 2 versus 12‐weeks of postoperative antibiotics after percutaneous nephrolithotomy in complex patients with infection‐related kidney stones

et al. 2022

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Purpose Treatment of struvite kidney stones requires complete surgical stone removal combined with antibiotic therapy to eliminate urinary tract infections and preventive measures to reduce stone recurrence. The optimal duration of antibiotic therapy is unknown. We sought to determine if 2‐ or 12‐weeks of antibiotics post percutaneous nephrolithotomy (PNL) for infection stones resulted in better outcomes for stone recurrence and positive urine cultures. Material and methods This multi‐center, prospective randomized trial evaluated patients with the clinical diagnosis of infection stones. Patients were randomized to 2‐ or 12‐weeks of postoperative oral antibiotics (nitrofurantoin or culture‐specific antibiotic) and included if residual fragments were ≤4 mm on computed tomography imaging after PNL. Imaging and urine analyses were performed at 3‐, 6‐, and 12‐months post‐procedure. Results Thirty‐eight patients were enrolled and randomized to either 2‐weeks (n = 20) or 12‐weeks (n = 18) of antibiotic therapy post‐PNL. Eleven patients were excluded due to residual fragments >4 mm, and 3 patients were lost to follow‐up. The primary outcome was the stone‐free rate (SFR) at 6 months post‐PNL. At 3‐, 6‐, and 12‐months follow‐up, SFRs were 72.7% versus 80.0%, 70.0% versus 57.1%, 80.0% versus 57.1% (p = ns), between 2‐ and 12‐week‐groups, respectively. At 3‐, 6‐, and 12‐months follow‐up, positive urine cultures were 50.0% versus 37.5%, 50.0% versus 83.3%, and 37.5% versus 100% between 2‐ and 12‐week groups, respectively (p = ns). Conclusions For patients with stone removal following PNL, neither 2‐weeks nor 12‐weeks of postoperative oral antibiotics is superior to prevent stones and recurrent positive urine cultures.

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Section: Discussionmentioning

confidence: 99%

Prospective randomized trial of 2 versus 12‐weeks of postoperative antibiotics after percutaneous nephrolithotomy in complex patients with infection‐related kidney stones

et al. 2022

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“…Urease inibitors could be theoretically used in the treatment of infected nephrolithiasis. Besides collateral effects and their low effectiveness, they are little used (19,20). Currently long-term antibiotic therapy is advised in patients with infected stones .…”

Section: Discussionmentioning

confidence: 99%

Metabolic evaluation in patients with infected nephrolithiasis: Is it necessary?

Cicerello

Mangano

Cova

et al. 2016

Arch Ital Urol Androl

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Fifty-four patients with infected renal lithiasis underwent complete metabolic evaluation searching for underlying factors contributing to stone formation including urine analysis and culture. Metabolic abnormalities were significantly more present in patients with mixed infected stones (struvite+/-apatite and calcium oxalate) than in patients with pure infected stones (struvite+/-carbonate apatite): hypercalciuria in 40%, hyperoxaluria in 34% and hyperuricosuria in 28% (p < 0.05). Urinary excretion of citrate was low in both groups without statistically significant difference (238+/-117 mg/24 h vs 214+/-104 mg/24/h, t = 0.72, p = 0.5). The few metabolic abnormalities present in patients with pure infected stones should suggest that urinary tract infection could change the urine chemistry in a lithogenic direction and be only cause of stone formation.

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“…However, many patients experience psychoneurologic, hematologic, and gastrointestinal side effects, with 22% unable to tolerate AHA. 27,29 The presence of renal insufficiency increases the risk of toxicity and results in decreased efficacy. Thus, AHA is contraindicated for patients with a creatinine level greater than 2.5 mg/dL 2 .…”

Section: Pharmacologic Treatment Options Infection Stonesmentioning

confidence: 99%

“…54,55 The presence of residual stone fragments in patients with infection stones composed of struvite and/or calcium carbonate apatite significantly increases the risk of stone recurrence, with a 0% to 10% recurrence rate for those who are stone free postoperatively versus 40% to 85% in the setting of residual stone fragments. 20,29 Patients who are rendered stone free have a lower rate of postoperative UTI (38%) versus those with residual fragments (64%). 29 After surgery, preventative measures may be helpful including dietary modifications as previously described in the nonpharmacologic section and urinary acidification and urease inhibitors as described in the pharmacologic section of this article.…”

Section: Evaluation Of Outcomes and Long-term Recommendations Infectimentioning

confidence: 99%

“…20,29 Patients who are rendered stone free have a lower rate of postoperative UTI (38%) versus those with residual fragments (64%). 29 After surgery, preventative measures may be helpful including dietary modifications as previously described in the nonpharmacologic section and urinary acidification and urease inhibitors as described in the pharmacologic section of this article. Sterilization of the urine with antibiotics may help decrease stone recurrence, as persistent infection is known to increase the risk of stone recurrence.…”

Section: Evaluation Of Outcomes and Long-term Recommendations Infectimentioning

confidence: 99%

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Treatment of the Infected Stone

Marien

Miller

2015

Urologic Clinics of North America

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Contemporary Management of Struvite Stones Using Combined Endourological and Medical Treatment: Predictors of Unfavorable Clinical Outcome

Cited by 5 publications

References 4 publications

Prospective randomized trial of 2 versus 12‐weeks of postoperative antibiotics after percutaneous nephrolithotomy in complex patients with infection‐related kidney stones

Prospective randomized trial of 2 versus 12‐weeks of postoperative antibiotics after percutaneous nephrolithotomy in complex patients with infection‐related kidney stones

Metabolic evaluation in patients with infected nephrolithiasis: Is it necessary?

Treatment of the Infected Stone

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