Is it Necessary for Patients With a Positive Urine Culture to Achieve a Negative Result After Antimicrobial Treatment Before Undergoing Percutaneous Nephrolithotomy?

For large renal stones, percutaneous nephrolithotomy (PCNL) is the recommended standard surgical approach, especially in cases involving infectious renal stones. Postoperative infections have become the most common complication associated with PCNL, often necessitating additional antimicrobial treatment and prolonged hospitalization. Therefore, it is critically important to identify the risk factors linked to infections after PCNL. Preoperative UC directs antibiotic treatment and mitigates infectious complications post-PCNL. Even with negative preoperative UCs and suitable antibiotic treatment, SIRS or sepsis may still develop post-PCNL. Several studies have indicated that a preoperative UC obtained before antibiotic administration is not a reliable predictor of postoperative infectious complications. Nonetheless, there has been limited research on the relationship between repeat UCs after antibiotic treatment and post-PCNL infectious complications. This research assesses the necessity of achieving a negative UC after treatment with sensitive antibiotics before undergoing PCNL.

Inclusion criteria

• Age ≥ 18 years.
• Renal stone diameter ≥ 2 cm, complex renal stones, or failed ESWL treatment.
• Consent to undergo PCNL with a positive midstream urine culture preoperatively.
• ASA score of I or II.

Exclusion criteria

• Coexisting renal tumor.
• Use of antibiotics within the past two weeks.
• Renal dysfunction (serum creatinine >451 μmol/L).
• Unresolved hemorrhage or coagulation abnormalities.
• Patients who have undergone percutaneous renal fistula or have a ureteral stent in place on the affected side.
• Simultaneous bilateral renal stone surgery.
• Severe underlying diseases, such as respiratory or circulatory insufficiency, that cannot tolerate anesthesia or surgery.
• Pregnant or lactating women.