Treatment of the Infected Stone

Marien, Tracy; Miller, Nicole L.

doi:10.1016/j.ucl.2015.05.009

Cited by 57 publications

(51 citation statements)

References 83 publications

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“…Whilst clinical outcome with both ureteric catheterisation and PCN for obstructive urolithiasis has been essentially similar [13], PCN placement has been found to be less expensive [14]. Availability of an interventional radiologist and longer waiting time for operating room favour PCN placement [15]. Considering these facts, emergency PCNs were placed by interventional radiologists in our institution for almost all the patients presenting with obstructive urolithiasis.…”

Section: Discussionmentioning

confidence: 95%

Predictors of renal recovery in renal failure secondary to bilateral obstructive urolithiasis

Rajadoss

Berry

Rebekah

et al. 2016

Arab Journal of Urology

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ObjectivesTo identify factors predicting renal recovery in patients presenting with renal failure secondary to bilateral obstructing urolithiasis.Patients and methodsData from electronic records of consecutive adult patients presenting with bilateral obstructing urolithiasis between January 2007 and April 2011 were retrieved. Ultrasonography of the abdomen, and kidney, ureter, bladder (KUB study) X-ray or abdominal non-contrast computed tomography confirmed the diagnosis. Interventional radiologists placed bilateral nephrostomies. Definitive intervention was planned after reaching nadir creatinine. Renal recovery was defined as nadir creatinine of ⩽2 mg/dL.ResultsIn all, 53 patients were assessed, 50 (94.3%) were male, and 18 (33.9%) were aged ⩽40 years. Renal recovery was achieved in 20 patients (37.7%). A symptom duration of ⩽25 days (P < 0.01), absence of hypertension (P = 0.018), maximum renal parenchymal thickness of >16.5 mm (P = 0.001), and haemoglobin >9.85 g/dL (P < 0.01) were significant on unadjusted analysis. Symptom duration of ⩽25 days alone remained significant after adjusted analysis. Symptom duration of ⩽25 days (hazard ratio (HR) 13.83, 95% confidence interval (CI) 4.52–42.26; P < 0.01), parenchymal thickness of ⩾16.5 mm (HR 5.91, 95% CI 1.94–17.99; P = 0.002), and absence of hypertension (HR 9.99, CI 95% 1.32–75.37; P = 0.026) were significantly related to time to nadir creatinine. Symptom duration of ⩽25 days (HR 17.44, 95% CI 2.48–122.79; P = 0.004) alone remained significant after adjusted analysis. A symptom duration of ⩽25 days (P = 0.007) was 22-times more likely to indicate renal recovery.ConclusionsShorter symptom duration (⩽25 days) is predictive of renal recovery in renal failure secondary to bilateral obstructive urolithiasis.

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Section: Discussionmentioning

confidence: 95%

Predictors of renal recovery in renal failure secondary to bilateral obstructive urolithiasis

Rajadoss

Berry

Rebekah

et al. 2016

Arab Journal of Urology

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“…Patients with an indwelling catheter are more likely to develop urinary stones [4,5]. Most are classified as infection stones, meaning that they have a bacterial etiology and often consist of struvite and/or apatite minerals [6].…”

Section: Cautis and Urinary Stonesmentioning

confidence: 99%

“…Most are classified as infection stones, meaning that they have a bacterial etiology and often consist of struvite and/or apatite minerals [6]. Although the prevalence of infection stones has decreased over the past 30 years, the overall prognosis is still poor: the 20-year mortality rate for infection stones is 28% with nonsurgical management, and 7% with surgical intervention [4]. Obstructive pyelonephritis, or a kidney stone that has blocked the kidney ducts, is one of the more severe complications of urinary stones, requiring immediate treatment to avoid serious complications such as urosepsis and death [4,7].…”

Section: Cautis and Urinary Stonesmentioning

confidence: 99%

From Catheter to Kidney Stone: The Uropathogenic Lifestyle of Proteus mirabilis

Norsworthy

Pearson

2017

Trends in Microbiology

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Proteus mirabilis is a model organism for urease-producing uropathogens. These diverse bacteria cause infection stones in the urinary tract and form crystalline biofilms on indwelling urinary catheters, frequently leading to poly-microbial infection. Recent work has elucidated how P. mirabilis causes all of these disease states. Particularly exciting is the discovery that this bacterium forms large clusters in the bladder lumen that are sites for stone formation. These clusters, and other steps of infection, require two virulence factors in particular: urease and MR/P fimbriae. Highlighting the importance of MR/P fimbriae is the cotranscribed regulator, MrpJ, which globally controls virulence. Overall, P. mirabilis exhibits an extraordinary lifestyle, and further probing will answer exciting basic microbiological and clinically relevant questions.

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“…Therefore, appropriate antibiotic treatment and careful attention are needed when an OPN patient undergoes URS. There has been some concerns that ureteral stent insertion could increase the risk of exacerbating urinary infection by stone manipulation and that it would be less effective for draining urine as compared with a large-caliber PCN tube [19]. However, previous studies have shown that either PCN or a ureteral stent could effectively relieve obstruction and infection associated with urinary stone [20,21].…”

Section: Discussionmentioning

confidence: 99%

The Risk Factors of Recurrent Febrile Urinary Tract Infection within 1 Year in Urinary Stone Patients with Acute Obstructive Pyelonephritis

Lee

Yoon

et al. 2017

Urogenit Tract Infect

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Purpose: To identify and evaluate the risk factors for the development of recurrent febrile urinary tract infection (fUTI) among patients with previous urinary stone and acute obstructive pyelonephritis (OPN). Materials and Methods:We retrospectively reviewed the medical records of 52 patients, who had urinary tract stones presented with OPN, between 2010 and 2015. Following their initial treatment, patients who were subsequently admitted with fUTI were included. Results: The mean age of patients was 62.2±14.6 years, and the mean follow-up duration was 26.0±20.39 months. Escherichia coli was found to be the dominating organism (68.2%, 15/22) in the initial urine culture. Patients were divided into two groups: The recurrent fUTI group (n=23) and the non-recurrent fUTI group (n=29). Between these two groups, significant differences were found with respect to diabetes history (recurrent group: 47.8% vs. non-recurrent group; 17.2%, p=0.018), stone location (kidney, 60.9% vs. ureter, 31.0%, p=0.031), and initially positive urine culture (60.9% vs. 27.6%, p=0.016). In a multivariate analysis, having an initially positive urine culture (95% confidence interval, 1.130-224.117; p=0.040) was identified as being an independent risk factor for developing recurrent fUTI. In a multivariate analysis, the initial laboratory test finding of acute renal insufficiency (ARI, p=0.019) and presence of a kidney stone (p=0.022) were significant factors associated with a newly-diagnosed-positive urine culture diagnosis. Conclusions: Having an initially positive urine culture was a significant risk factor for the development of recurrent fUTI in urinary stone patients with acute OPN. In addition, repeated urine tests were also needed in patients with ARI or renal stones during the follow-up period.

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Treatment of the Infected Stone

Cited by 57 publications

References 83 publications

Predictors of renal recovery in renal failure secondary to bilateral obstructive urolithiasis

Predictors of renal recovery in renal failure secondary to bilateral obstructive urolithiasis

From Catheter to Kidney Stone: The Uropathogenic Lifestyle of Proteus mirabilis

The Risk Factors of Recurrent Febrile Urinary Tract Infection within 1 Year in Urinary Stone Patients with Acute Obstructive Pyelonephritis

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