Ripa Francesco, Atiya Ayah, Quistini Alberto, Cerrato Clara, Gauhar Vineet, Somani Bhaskar
Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
Department of Urology, Homerton Healthcare NHS Foundation Trust, London, UK.
World J Urol. 2025 Jul 17;43(1):447. doi: 10.1007/s00345-025-05558-9.
Urosepsis is a potential life-threatening complication of minimally invasive endourological procedures. High discordance rates exist between bladder urine cultures and cultures from the upper tract (renal pelvis and stones cultures). Aim of this systematic review is to summarise the evidence on the clinical value of pre-operative bladder urine culture (PBUC), renal pelvis urine culture (RPUC) and stone cultures (SC) in predicting post-operative infective complications after URS or PCNL.
A systematic review was performed in accordance to the PRISMA guidelines. The PICO model of the clinical search question was: Patients - patients undergoing PCNL or URS; Intervention - intra-operative RPUC and SC; Comparison - compared to pre-operative BUC; Outcome - prediction of post-operative systemic inflammatory response syndrome (SIRS) or sepsis. Studies included were published between 2004 and 2024.
21 studies were included. PBUC was shown to have a poor concordance rate with intra-operative cultures. PBUC had a lower value in predicting post-operative SIRS and sepsis compared to intra-operative cultures. A significant concordance rate was found between RPUC and SC. SC were the best predictors of the development of post-operative SIRS and urosepsis.
A pre-operative bladder urine culture is often not representative of the upper tract microbiological environment. Collecting renal pelvis urine cultures and stone cultures during RIRS and PCNL should be the standard of care, especially in high risk patients.
尿脓毒症是微创腔内泌尿外科手术潜在的危及生命的并发症。膀胱尿液培养结果与上尿路（肾盂和结石培养）结果之间存在较高的不一致率。本系统评价的目的是总结术前膀胱尿液培养（PBUC）、肾盂尿液培养（RPUC）和结石培养（SC）在预测输尿管镜检查（URS）或经皮肾镜取石术（PCNL）术后感染性并发症方面临床价值的证据。
按照PRISMA指南进行系统评价。临床检索问题的PICO模型为：患者——接受PCNL或URS的患者；干预——术中RPUC和SC；对照——与术前BUC比较；结局——术后全身炎症反应综合征（SIRS）或脓毒症的预测。纳入的研究发表于2004年至2024年之间。
纳入21项研究。结果显示PBUC与术中培养结果的一致性较差。与术中培养相比，PBUC在预测术后SIRS和脓毒症方面价值较低。RPUC和SC之间存在显著的一致性率。SC是术后SIRS和尿脓毒症发生的最佳预测指标。
术前膀胱尿液培养往往不能代表上尿路的微生物环境。在逆行肾内手术（RIRS）和PCNL期间采集肾盂尿液培养和结石培养应成为标准治疗方法，尤其是在高危患者中。
