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Objective:To investigate the pathogenic bacteria profiles in preoperative urine bacterial cultures of patients with infected kidney stones and use antibacterial drugs to prevent recurrence.Methods:The data of 79 cases with infected kidney stones admitted to the Second Affiliated Hospital of Zhengzhou University from January 2017 to July 2021 were retrospectively analyzed, among whom 29 (36.7%) were male and 50 (63.3%) were female. The age ranged from 17-75 years, with a median age of 49.0 (40, 55) years. Fifteen cases (19.0%) combined hypertension, 13 cases (16.5%) combined diabetes mellitus, and 3 cases (3.8%) combined with cardiovascular disease. Fifty-one cases (64.6%) were diagnosed with cast infectious stones. All patients underwent surgical lithotripsy, and postoperative review of the urological computerized tomography (CT) revealed no residual stones defined as complete lithotripsy, and postoperative oral medication was continued to control infection and prevent stone recurrence. According to post-hospitalization compliance, patients were divided into high and low compliance groups. The high compliance group consisted of patients who returned to the hospital regularly for routine urinalysis and urine bacterial culture after discharge, followed the doctor's prescription for standardized antibacterial drug therapy, and complied with urease inhibitor therapy for ≥6 months. The low compliance group included patients who did not take sensitive antimicrobial drugs regularly and/or were unable to adhere to the medication even after the reduction of vinblastine due to adverse events such as tremor, palpitations, headache, anemia, or gastrointestinal discomfort. The recurrence of stones at 3, 6 and 12 months of follow-up was compared between the two groups.Results:Of the 79 cases in this group, 56(70.9%) were completely clear of stone after surgery. Thirty-three cases (41.8%) presented positive in preoperative urine bacterial culture, and the most common causative organism was Aspergillus oddus in 17 cases (21.5%), followed by Escherichia coli in 8 cases (10.1%) and Klebsiella pneumoniae in 3 cases (3.8%). Among the 17 positive cases of A. oddis, six were positive for ultra broad spectrum β-lactamases (ESBLs), 6/6 were resistant to ampicillin, cefazolin, and cotrimoxazole, 1/6 were resistant to amikacin, cefoxitin, and ticarcillin/stick acid, and none were resistant to imipenem, polymyxin, or aminotrans (0/6 cases). Of the cases, 11 were negative for ESBLs. Ten out of eleven cases were resistant to ampicillin. Furthermore, 8/11 cases were resistant to cefazolin, levofloxacin, ciprofloxacin, and cotrimoxazole and 1/11 were resistant to cefoxitin, cefaclor, furantoin, amikacin, and minocycline, and 0/11 were resistant to imipenem, ticarcillin/stick acid, aminotrans. ESBLs positive strains were resistant to 78.6% of the tested drugs (cefaclor, cefazolin, ceftazidime, furantoin, norfloxacin, levofloxacin, ciprofloxacin, cefoxitin, amoxicillin/rod acid, ticarcillin/rod acid, ampicillin, ceftriaxone, cefotaxime, cefuroxime, cefepime, gentamicin, cotrimoxazole, tobramycin, amikacin, tetracycline, chloramphenicol, and minocycline) at a lower rate of resistance than ESBLs positive strains. Of the eight positive cases of E. coli, seven were ESBLs positive, 7/7 were resistant to ampicillin, cefazolin, cefotaxime, cefuroxime, and cefepime, 1/7 were resistant to cefoxitin and minocycline, and 0/7 were resistant to imipenem, furantoin, or amikacin. One case was ESBLs negative and was resistant to all antimicrobial drugs except for ampicillin. Stone recurrence rates at 3, 6, and 12 months after discharge were 9.1%(4/44) and 31.4%(11/35), 13.6%(6/44), respectively, in the high compliance group, and 60.0%(21/35), 36.4%(16/44), and 71.4% (25/35), respectively, in the low compliance group. All differences were statistically significant.Conclusion:The most common pathogenic bacteria isolated from urine bacterial cultures of patients with infectious stones were A. chimaera, E. coli, and K. pneumoniae. The resistance rate of ESBLs-positive strains to antimicrobial drugs was significantly higher than that of ESBL-negative strains, and the resistance rate of antimicrobial drugs such as β-lactamase inhibitors, cefoxitin, amikacin, and imipenem was low. Combination therapy with standardized sensitive antimicrobial drugs and urease inhibitors significantly reduced the recurrence rate of stones among patients.
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Objective:To explore risk factors for the efficacy and complications of surgery for infectious kidney stones.Methods:The clinical data of 75 patients with infection kidney stones from January 2015 to May 2022 were retrospectively analyzed. This group of 75 patients, were 23 to 74 of age, with mean of (49.3±10.4) years old. Among them, 25 were male and 50 were female. The mean diameter of the stones was (5.4±2.7)cm. There were 29 cases of staghorn stones, 25 cases of multiple kidney stones, and 21 cases of single kidney stones. Preoperative renal function measuring by creatinine was 68 (51, 68)μmol/L. Twenty-five patients (33.3%) were combined with comorbidities, including diabetes mellitus, neurogenic bladder, spinal cord injury, cerebrovascular disease, or urinary anatomical malformation. All the patients underwent surgical treatment, including percutaneous nephrolithotomy, flexible ureteroscopy, and combined endoscopy. Postoperatively, urosepsis was diagnosed according to the SOFA score. One month after the operation, CT or KUB were re-examined to evaluate the efficacy of the operation. Multivariate logistic regression was used to analyze the risk factors for surgical efficacy, complications and sepsis.Results:All 75 patients undewent successful surgery. The overall stone clearance rate was 64%, and the single-factor analysis showed that the stone diameter ( P=0.001) and stone type ( P=0.002) were the impacting factors of the surgical efficacy of infectious kidney stone. Multivariate analysis showed that stone type ( OR=2.55, 95% CI 1.00-6.51, P=0.049) was an independent risk factor influencing the efficacy of surgery for infectious kidney stones. A total of 24 cases experienced surgical complications after surgery, including 18 cases of infection, 3 cases of bleeding, and 3 cases of subcapsular hemorrhage, and the complication rate was 32.0%(24/75). Univariate analysis showed that hydronephrosis ( P=0.039), comorbidities ( P=0.009), and preoperative renal function ( P=0.008) were risk factors for postoperative complications of infectious nephrolithiasis, and multivariate analysis showed that comorbidities ( OR=0.21, 95% CI 0.05-0.90, P=0.029) were independent risk factors for postoperative complications. The incidence of postoperative urosepsis was 6.7%, and univariate analysis did not find any risk factors for sepsis. Conclusions:Stone type is a factor that affects the efficacy of surgery for infectious kidney stones, and comorbidities are factors that affect surgical complications.
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Objective To investigate the preventive effect of potassium citrate sustained-release tablets on the formation of adherent stone in ureteral stent-graft after retrograde intrarenal surgery. Methods Patients with upper urinary tract calculi after retrograde intrarenal surgery and without stasis confirmed by color ultrasound were randomly divided into test group and control group. Patients in test group were given potassium citrate sustained release tablets 3 times(1.08 grams each time)orally but those in the control group did not take the drug. Two groups of patients received conventional health education and diet guidance. The formation of adherent stone in ureteral stent-graft during surgical removal of ureteral stent and the adverse reactions during taking the medication 3,6 and 16 weeks after the surgery were compared. Results There were few cases of adherent stone formed 3 weeks after the operation,which can not be statistically analyzed. The incidence of adnexal calculus in the test group 6 and 16 weeks after the operation was significantly lower than that of the control group,which was statistically significant.No serious adverse reactions and complications occurred in the test group during the medication-taking. Conclusions Potassium citrate sustained-release tablet is safe and effective for preventing the formation of adher-ent stone in ureteral stent-graft after upper urinary tract calculi retrograde intrarenal surgery.
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Objective To observe the curative effect of external physical vibration lithecbole (EPVL) therapy after extracorporeal shock-wave lithotripsy (ESWL) in upper urinary calculi.Methods A total of 133 patients of upper urinary calculi with randomly divided into 2 groups after ESWL therapy during the period of 2012 October to 2013 February.The EPVL group (66 cases) used the physical vibration lithecbole treatment,and the natural lithecbole group (67 cases) used the method by drinking water,adding exercise and other natural lithecbole method.Of the EPVL group,6 of the stones were located in the upper or middle calyx,13 in renal pelvis,16 in lower renal calyx and 31 in ureter,the stone diameter was 10-15 mm.Of the natural lithecbole group,8 of the stones were located in the upper or middle calyx,17 in renal pelvis,15 in lower renal calyx and 27 in ureter,the stone diameter was 10-15 mm.The clinical data of the curative effect,side-effect,and complications were collected and analyzed systematically.Results In the EPVL group,the average times of lithagogue treatment was 2.6 times,51 patients (77％) expelled stones on the day of lithecbole,and the stone free rate in a week was 79％ (52/66).Especially,81％ (13/16) of the lower renal calyx expelled stones on the day of lithecbole,and the stone free rate in a week was 88％ (14/16).Whereas,30 patients (45％) in the natural lithecbole group expelled stones on the day of ESWL,and the stone free rate in a week was 49％ (33/67) ; the lower renal calyx stone expulsion rate on the day of ESWL was 33％ (5/15),and the stone free rate in a week was 40％ (6/15).The curative effects were significantly different between the 2 groups (P＜ 0.05).There were no serious complications in both groups.Conclusions EPVL machine can significantly promote the stone expulsion after ESWL.Compared with traditional methods,EPVL therapy has a better curative effect,especially on lower renal calyx stones.EPVL is a safe and noninvasive treatment.
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Objective To evaluate the clinical value of determination of composition of kidney stones by shap and density and of prediction of the efficacy of extracorporeal shock-wave lithotripsy (ESWL) by X-rays. Methods The data of 358 patients were analyzed,with 204 male and 154 female and with 276 cases of solitary stones and 82 cases of multiple stones.Determine the composition of kidney stones by shap and density,predict the efficacy of ESWL by X-rays,and choose the appropriate method of treatment.Analyze stone chemical property by Infrared stone composition automatic analyzer to checkout the prediction results before surgeries. Results 339 cases were successful to remove stones after treatment.The prediction results of 308 cases (86.0％) were consistent in stone chemical property,and the preperative prediction results of 339 cases (94.7％) were consistent in ESWL efficacy. Conclusions Determination of composition of kidney stones and prediction of the efficacy of ESWL by X-rays were feasible.