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Routine urine culture is not necessary prior to endourological procedures for treatment of nephrolithiasis
Seth K. Bechis, MD MS, Brian H. Eisner, MD.
Massachusetts General Hospital, Boston, MA, USA.

INTRODUCTION:
Routine urine culture is common practice prior to shockwave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PCNL). However, there is little evidence to support this practice for patients without history of infection and with a urinalysis that does not show the presence of infection. The aim of this study was to review the postoperative infectious complications after SWL, URS, and PCNL in patients with a negative preoperative urine nitrite on dipstick and who did not undergo preoperative urine culture.
MATERIALS AND METHODS:
An IRB-approved retrospective review of surgical procedures for the treatment of nephrolithiasis performed by a single surgeon at a tertiary care center between November 2009 and October 2013 was performed to identify patients who underwent a procedure without having a preoperative urine culture. The procedures included SWL, URS, and PCNL. In our current practice, urine cultures are only sent for patients with a nitrite positive urine, recent episode of cystitis or pyelonephritis, those with struvite stones, or those who report a history of infection. Exclusion criteria were patients undergoing staged procedures or who had a preoperative urine culture obtained within 30 days of surgery. All patients were seen within 4 weeks for follow-up, and the incidence of postoperative urinary tract infections (UTIs) and fevers was recorded.
RESULTS:
One hundred sixty patients met inclusion criteria (i.e. patient had either SWL, URS, or PCNL, a nitrite-negative preoperative urinalysis, and did NOT have a preoperative urine culture): 45 PCNL (28%), 67 URS (42%), and 48 SWL (30%) procedures. All patients received perioperative antibiotics according to the AUA guidelines. No patients developed fever or urinary tract infection after SWL. A single URS patient (0.6% of overall cohort, 1.5% of URS cohort) developed fever after stent removal, was readmitted for stent replacement and treated for urosepsis. In the PCNL cohort, 4 patients (9%) developed postoperative fevers and all had urine and blood cultures, but none of these cultures demonstrated the presence of bacteruria or bacteremia.
CONCLUSIONS:
Of 160 patients undergoing SWL, URS, or PCNL without preoperative urine culture, a single patient developed postoperative urinary tract infection. This is consistent with the incidence of postoperative urinary tract infection in the literature. In carefully selected patients, elimination of preoperative urine culture may save cost without affecting procedure or treatment outcomes.


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