Extracorporeal Shock Wave Lithotripsy (ESWL) Versus Percutaneous Nephrolithotomy (PCNL) in the Eradication of Persistent Bacteriuria Associated with Infected Stones

Abstract

Infected stones function as a sanctuary for organisms and may attenuate the effects of antibiotics against them. Therefore, to treat urinary tract infection associated with urinary calculi, complete extirpation of the stones is necessary. The obtained results indicated that out of the 73 patients included in the study, only 67 patients were available for follow-up (32 underwent ESWL and 35 PCNL). Out of the 35 patients treated with PCNL, 32 patients (91.4 %) were rendered stone free and only 2 patients out of the 3 patients with residual stones showed evidence of persistent bacteruria (5.7 %). while 32 patients treated with ESW L, only 16 patients (50 %) were stone free and 13 patients out of the other 16 with residual stones showed evidence of persistent bacteruria (40.6 %). A positive relation was found between the residual stone fragments and persistent bacteruria, as all patients in either group who were stone free were free of persistent infection. The study also showed that in the ESW L group, with small stones less 2cm, the result of eradication of stones and persistent infection was much better than with large stones more than 2cm (90.9 % vs. 28.6 %).Another finding is that the incidence of residual infected stone fragment was directly related to the degree of hydronephrosis. PCNL is better than ESW L monotherapy in the eradication of persistent bacteruria associated with infected stone specially when associated with moderate and marked hydronephrosis as it had much better clearance rate of residual infected stone fragments.

Does Stone Removal Help Patients with Recurrent Urinary Tract Infections?

“…PCNL has been demonstrated to be the preferred option in the clearance of recurrent bacteriuria from infected stones 16,17 . PCNL has a superior stone clearance rate which precludes residual stone fragments from continuing to act as a nidus for repeat infections 16,17 . ESWL's bactericidal effect has been studied in the hopes of utilizing the shockwaves for clearance of recurrent infections associated with stones.…”

“…Struvite and secondarily infected calcium stones can manifest clinically as recurrent urinary tract infections 16,17,18 . PCNL has been demonstrated to be the preferred option in the clearance of recurrent bacteriuria from infected stones 16,17 .…”