Secondarily infected nonstruvite urolithiasis: A prospective evaluation

Mitra R. De Cógáin, John C Lieske, Terri J Vrtiska, Pritish K. Tosh, Amy E. Krambeck

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1295-1300
Number of pages6
JournalUrology
Volume84
Issue number6
DOIs
StatePublished - Dec 1 2014

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Urolithiasis
Neurogenic Urinary Bladder
Calculi
citrate (pro-3S)-lyase
Struvite
Percutaneous Nephrostomy
Urease
Crystallization
Bacterial Infections
Infertility
Medical Records
Spectrum Analysis
Tomography
Inflammation
Bacteria

ASJC Scopus subject areas

  • Urology

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Secondarily infected nonstruvite urolithiasis : A prospective evaluation. / De Cógáin, Mitra R.; Lieske, John C; Vrtiska, Terri J; Tosh, Pritish K.; Krambeck, Amy E.

In: Urology, Vol. 84, No. 6, 01.12.2014, p. 1295-1300.

Research output: Contribution to journalArticle

De Cógáin, Mitra R. ; Lieske, John C ; Vrtiska, Terri J ; Tosh, Pritish K. ; Krambeck, Amy E. / Secondarily infected nonstruvite urolithiasis : A prospective evaluation. In: Urology. 2014 ; Vol. 84, No. 6. pp. 1295-1300.
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abstract = "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.",
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AU - Krambeck, Amy E.

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N2 - 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.

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.

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