Antimicrobial prophylaxis in management of urinary tract stones by extracorporeal shock-wave lithotripsy: Is it necessary?

Ilker, Y; Türkeri, Levent; Korten, Volkan; Tarcan, Tufan; Akdaş, Atıf

doi:10.1016/s0090-4295(99)80187-3

Cited by 25 publications

(12 citation statements)

References 15 publications

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“…This is in accordance with a recent study per formed by Ilcker et al [16] who evaluated the incidence of urinary tract infection following ESWL in 360 consecu tive patients receiving either placebo or prophylaxis: Only 0.8% of the patients had a positive urine culture at 1 week after ESWL.…”

Section: Antibiotic Prophylaxis During Eswlsupporting

confidence: 91%

The Value of Antibiotic Prophylaxis during Extracorporeal ShockWave Lithotripsy in the Prevention of Urinary Tract Infections in Patients with Urine Proven Sterile prior to Treatment

Bierkens¹,

Hendrikx²,

Din³

et al. 1997

Eur Urol

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Introduction: There are controversies in the literature regarding the need for and duration of antibiotic prophylaxis in patients treated with extracorporeal shock wave lithotripsy (ESWL) who have a negative urine culture before treatment. In order to determine the efficacy of antibiotic prophylaxis in ESWL treatment of patients with proven sterile urine, a radnomized trial was performed. Methods: Patients were randomized for placebo and 1 or 7 days antibiotic prophylaxis (cefuroxime or ciprofloxacin), starting 30 min before ESWL. Post-ESWL studies (immediately and 2 and 6 weeks after ESWL) included patient history, urine culture and Gram stain. Results: After 2 weeks 20% of the patients and after 6 weeks 23% of the patients had bacteriuria, but there was no statistical significance between patients treated with placebo or those receiving prophylactic treatment. Only 2-3% of the patients (in the prophylaxis and placebo group) had clinical and bacteriological signs of a urinary tract infection, either 2 or 6 weeks after ESWL, possibly caused by re-infection, however, since bacteria were found in none of the urine samples collected directly after ESWL. There was no beneficial effect of antibiotic prophylaxis in the prevention of urinary tract infections in patients with a nephrostomy catheter or dilatation at the site of treatment. Conclusion: We conclude that in patients with urine proven sterile prior to ESWL there is no need for antibiotic prophylaxis.

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Section: Antibiotic Prophylaxis During Eswlsupporting

confidence: 91%

The Value of Antibiotic Prophylaxis during Extracorporeal ShockWave Lithotripsy in the Prevention of Urinary Tract Infections in Patients with Urine Proven Sterile prior to Treatment

Bierkens¹,

Hendrikx²,

Din³

et al. 1997

Eur Urol

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“…Some investigators concluded that prophylactic antibiotic during ESWL are unnecessary in patients whose urine before treatment was sterile (24), other studies showed that antibiotic prophylaxis with several agents can reduce the rate of bacteriuria significantly (25). Currently, many urologists routinely prescribe antibiotic prophylaxis to reduce the potential risk.…”

Section: Commentsmentioning

confidence: 99%

Extracorporeal shockwave lithotripsy versus ureteroscopy for distal ureteric calculi: efficacy and patient satisfaction

2006

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Objective: We compared the efficacy of extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy (URS) for the treatment of distal ureteral calculi with respect to patient satisfaction. Materials and Methods: This is a prospective study where a total of 212 patients with solitary, radiopaque distal ureteral calculi were treated with ESWL (n = 92) using Dornier lithotriptor S (MedTech Europe GmbH) or URS (n = 120). Patient and stone characteristics, treatment parameters, clinical outcomes, and patient satisfaction were assessed for each group. Results: The 2 groups were comparable in regard to patient age, sex, stone size, and side of treatment. The stone-free status for ESWL and URS at 3 months was 81.5% and 97.5%, respectively (p < 0.0001). In addition, 88% of patients who underwent ESWL versus 20% who underwent URS were discharged home the day of procedure. Minor complications occurred in 3.3% and 8.3% of the ESWL and URS groups, respectively (p = 0.127). No ureteral perforation or stricture occurred in the URS group. Postoperative flank pain and dysuria were more severe in the URS than ESWL group, although the differences were not statistically significant (p = 0.16). Patient satisfaction was high for both groups, including 94% for URS and 80% for ESWL (p = 0.002). Conclusions: URS is more effective than ESWL for the treatment of distal ureteral calculi. ESWL was more often performed on an outpatient basis, and showed a trend towards less flank pain and dysuria, fewer complications and quicker convalescence. Patient satisfaction was significantly higher for URS according to the questionnaire used in this study.

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“…After referring to full texts, 9 publications (RCTs) involving 1,364 patients were included in the study. [13][14][15][16][17][18][19][20][21] Characteristics and quality of the included studies are presented in tables 1 and 2, and the search flow diagram is presented in figure 1. There were no significant differences in baseline information between the 2 groups.…”

Section: Description Of Studiesmentioning

confidence: 99%

“…[13][14][15][16][17][18]20 In these RCTs UTI developed in 0% to 14.0% of patients after SWL, including 0% to 14.0% of controls and 0% to 12.0% of those on prophylaxis (table 4). Furthermore, there were no significant differences between the 2 groups in the incidence of short-term UTI (RR 0.55, 95% CI 0.29 -1.04, p ϭ 0.06), the incidence of midterm UTI (RR 0.49, 95% CI 0.05-5.34, p ϭ 0.56) 13,18 and the overall incidence of UTI (RR 0.54, 95% CI 0.29 -1.01, p ϭ 0.05, fig. 4).…”

Section: Urinary Tract Infectionmentioning

confidence: 99%

Antibiotic Prophylaxis for Shock Wave Lithotripsy in Patients with Sterile Urine Before Treatment May be Unnecessary: A Systematic Review and Meta-Analysis

et al. 2012

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Antimicrobial prophylaxis in management of urinary tract stones by extracorporeal shock-wave lithotripsy: Is it necessary?

Cited by 25 publications

References 15 publications

The Value of Antibiotic Prophylaxis during Extracorporeal ShockWave Lithotripsy in the Prevention of Urinary Tract Infections in Patients with Urine Proven Sterile prior to Treatment

The Value of Antibiotic Prophylaxis during Extracorporeal ShockWave Lithotripsy in the Prevention of Urinary Tract Infections in Patients with Urine Proven Sterile prior to Treatment

Extracorporeal shockwave lithotripsy versus ureteroscopy for distal ureteric calculi: efficacy and patient satisfaction

Antibiotic Prophylaxis for Shock Wave Lithotripsy in Patients with Sterile Urine Before Treatment May be Unnecessary: A Systematic Review and Meta-Analysis

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