Omar Mohamed, Abdulwahab-Ahmed Abdullahi, Chaparala Hemant, Monga Manoj
Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
J Urol. 2015 Oct;194(4):997-1001. doi: 10.1016/j.juro.2015.04.096. Epub 2015 Apr 30.
We evaluated the impact of surgical extraction of nonobstructing asymptomatic stones on recurrent urinary tract infections and identified predictors of patients who may be rendered infection-free.
We retrospectively reviewed charts to identify patients with recurrent urinary tract infections who underwent surgical stone extraction and were rendered stone-free. Demographic variables as well as procedure, infectious etiology, stone composition and the systemic inflammatory response syndrome rate were also recorded. Patients were divided into 2 groups. Group 1 had no evidence of recurrent infection following surgery while recurrent infection developed in group 2. Univariate analysis was performed using the Wilcoxon signed rank and Fisher exact tests. Logistic regression was used for multivariate analysis.
We identified 120 patients with recurrent urinary tract infections and a nonobstructive renal stone. Surgical management included shock wave lithotripsy in 32% of cases, ureteroscopy in 7% and percutaneous nephrolithotomy in 61%. Of the 120 patients 58 (48%) remained infection-free after surgery while 62 (52%) experienced recurrent infection. Factors associated with a higher risk of recurrent infections included type 2 diabetes mellitus (OR 1.73, p = 0.01), hypertension (OR 2.8, p = 0.007) and black ethnicity (OR 13.7, p = 0.009). Escherichia coli infections were more likely to resolve (OR 0.34, p = 0.01). In contrast, Enterococcus infections were more likely to persist (OR 2.5, p = 0.04). On multiple logistic regression analysis only race, hypertension and E. coli infections were significant predictors of infection clearance.
Of patients with recurrent urinary tract infections and asymptomatic renal calculi 50% may be rendered infection-free following stone extraction. Patients with risk factors for recurrent infections after surgery should be counseled that stone extraction might not eradicate the infection.
我们评估了手术取出无梗阻性无症状结石对复发性尿路感染的影响，并确定了可能实现无感染的患者的预测因素。
我们回顾性查阅病历，以确定接受手术取石且结石清除的复发性尿路感染患者。记录人口统计学变量以及手术、感染病因、结石成分和全身炎症反应综合征发生率。患者分为两组。第1组术后无复发性感染证据，而第2组发生了复发性感染。使用Wilcoxon符号秩检验和Fisher精确检验进行单因素分析。使用逻辑回归进行多因素分析。
我们确定了120例复发性尿路感染且有非梗阻性肾结石的患者。手术治疗包括32%的病例采用冲击波碎石术，7%采用输尿管镜检查，61%采用经皮肾镜取石术。120例患者中，58例（48%）术后保持无感染，而62例（52%）经历了复发性感染。与复发性感染风险较高相关的因素包括2型糖尿病（OR 1.73，p = 0.01）、高血压（OR 2.8，p = 0.007）和黑人种族（OR 13.7，p = 0.009）。大肠杆菌感染更有可能得到解决（OR 0.34，p = 0.01）。相比之下，肠球菌感染更有可能持续存在（OR 2.5，p = 0.04）。在多因素逻辑回归分析中，只有种族、高血压和大肠杆菌感染是感染清除的显著预测因素。
复发性尿路感染和无症状肾结石患者中，50%在取石后可能实现无感染。对于术后有复发性感染风险因素的患者，应告知其取石可能无法根除感染。
