Secondarily infected nonstruvite urolithiasis: a prospective evaluation.
Objective: To characterize patients who form nonstruvite stones associated with infection (secondarily infected calculi), and to define the bacteria associated with these.Materials and Methods: Patients undergoing percutaneous nephrolithotomy were prospectively recruited. Medical records were review...
| Publicado en: | Urology Vol. 84; no. 6; pp. 1295 - 1301 |
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| Autores principales: | , , , , |
| Formato: | research Journal Article |
| Publicado: |
Elsevier B.V.
Dec2014
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103855731&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 103855731 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00904295 1YG jtl: Urology issn: 00904295 maglogo: N pubinfo: dt: Dec2014 vid: 84 iid: 6 pid: 467 pub: Elsevier B.V. place: New York, New York artinfo: ui: 103855731 NLM25306481 2012817242 10.1016/j.urology.2014.08.007 NLM25306481 PMC4257060 103855731 ppf: 1295 ppct: 6 formats: tig: atl: Secondarily infected nonstruvite urolithiasis: a prospective evaluation. aug: au: de Cógáin, Mitra R Lieske, John C Vrtiska, Terri J Tosh, Pritish K Krambeck, Amy E affil: Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN. sug: subj: Magnesium Compounds Urinary Diversion Adverse Effects Phosphates Urinary Tract Infections Microbiology Urolithiasis Microbiology Urolithiasis Surgery Adult Aged Acids, Acyclic Prospective Studies Female Human Incidence Male Middle Age Urinary Diversion Methods Postoperative Care Preoperative Care Prognosis Risk Assessment Uric Acid Urinalysis Urinary Tract Infections Epidemiology Urinary Tract Infections Etiology Urinary Tract Infections Physiopathology Urolithiasis Complications Urolithiasis Diagnosis Adult: 19-44 years Aged: 65+ years Middle Aged: 45-64 years Female Male ab: Objective: To characterize patients who form nonstruvite stones associated with infection (secondarily infected calculi), and to define the bacteria associated with these.Materials and Methods: Patients undergoing percutaneous nephrolithotomy were prospectively recruited. Medical records were reviewed, and stones were analyzed using micro computed tomography and infrared spectroscopy. A fragment of each stone was sent for bacterial culture. Patients were categorized by stone culture results (SC ±) and the presence of struvite (ST ±). The Fisher exact test was used for comparison of proportion. Sterility of intraoperative SC was established with independently collected controls.Results: In total, 125 patients were enrolled: 24 SC+/ST-, 19 SC+/ST+, and 82 SC-/ST-. Proportions of patients with prior urologic surgery, diabetes, and immunodeficiency were similar between groups. Patients with neurogenic bladder were more likely to have SC+/ST+ stones or SC+/ST- stones than SC-/ST- stones (26% vs 8% vs 0%, respectively; P <.01). Among patients with metabolic evaluations, hypocitraturia was found in 31.6% (6 of 19) SC+/ST- patients, 46.7% (7 of 15) SC+/ST+ patients, and 26.0% (19 of 73) of SC-/ST- patients (P = .28). Approximately 40% of cultured organisms in the secondarily infected calculi possessed urease and another 40% citrate lyase activities.Conclusion: Secondarily infected stones were detected in approximately 20% of this surgical cohort and may be more common than previously appreciated. Neurogenic bladder appeared to predispose patients to either struvite or secondarily infected stones. The role of bacterial infection in stone formation is unclear but may include alteration of urinary components, acting as a nidus for crystallization, or inducing inflammation. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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