The Problem of Recurrences and Infection after Surgical Removal of Staghorn Calculi

Ja, Martínez-Piñeiro; Eg, de Iriarte; Ah, Armero

doi:10.1159/000473488

Cited by 14 publications

(7 citation statements)

References 13 publications

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“…Thus, eradication of the infection and elimination of the source of urease with antibiotics is a critical step in stone prevention. Martinez-Pineiro and colleagues [59] reported on 99 consecutive patients surgically treated for staghorn calculi. Of those patients stone-free following the operation, 31.5% had a recurrence, and 56.5% had resistant urinary tract infection.…”

Section: Antibioticsmentioning

confidence: 99%

Pathophysiology and Management of Infectious Staghorn Calculi

Healy

Ogan

2007

Urologic Clinics of North America

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Section: Antibioticsmentioning

confidence: 99%

Pathophysiology and Management of Infectious Staghorn Calculi

Healy

Ogan

2007

Urologic Clinics of North America

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“…The complete clearance of all stone material is crucial because remaining fragments can serve as a nidus for new stone formation, also considering the rapid growth of these stones. Recurrence rates are very high if residual fragments remain in place [ 42 ].…”

Section: Resultsmentioning

confidence: 99%

Is There Still a Place for Percutaneous Nephrolithotomy in Current Times?

Lorenzis

Zanetti

Boeri

et al. 2022

JCM

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Background: Percutaneous nephrolithotomy (PCNL) and its miniaturized modifications are usually considered the standard surgical options for large (>20 mm) staghorn and infected stones. Moreover, PCNL is a viable alternative to retrograde intrarenal surgery (RIRS) for smaller stones (<20 mm) in the presence of anatomical malformations or inaccessible lower pole stones. However, due to the advancements in laser and scope technology, RIRS is expanding its indications with the potential benefits of lower complications and a shorter hospital stay. Methods: A literature search using the PUBMED database from inception to June 2022 was performed to explore the current role of PCNL in endourology. The analysis involved a narrative synthesis. Results: PCNL confirmed its role in the treatment of large and complex stones; moreover, miniaturized PCNL has become more competitive, gaining space among classic indications of flexible ureteroscopy. Conclusions: considering all the evaluated subgroups, we can conclude that PCNL is an old fascinating procedure and is here to stay.

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“…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. 11 For patients with presumed infection stones, parenteral broad-spectrum antibiotics were administered pre-operatively the evening before PNL, peri-operatively, and continued through the first shock wave lithotripsy procedure on days 3 to 4.…”

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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The Problem of Recurrences and Infection after Surgical Removal of Staghorn Calculi

Cited by 14 publications

References 13 publications

Pathophysiology and Management of Infectious Staghorn Calculi

Pathophysiology and Management of Infectious Staghorn Calculi

Is There Still a Place for Percutaneous Nephrolithotomy in Current Times?

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

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