Possibilities for predicting infectious and inflammatory complications in patients with urinological disease in the postoperative period

The purpose of our work was to assess the possibility of predicting the risks of postoperative complications in patients with urolithiasis in a urological hospital.

Materials and methods. We performed a retrospective comparative study. We analyzed the medical records of patients in the department of urology of hospital clinics of Siberian State Medical University from November 2022 to May 2023. A total of 48 records of patients who had a verified diagnosis of urolithiasis were selected. Inclusion criteria were the presence of stones in the kidney or ureter and surgical intervention during the current hospitalization. Exclusion criteria included bladder stones. All patients underwent surgery for urolithiasis. The laboratory range of studies included a general urine test before surgery, bacteriological examination of urine for microflora and sensitivity to antibacterial drugs before surgery, as well as bacteriological examination of stone obtained intraoperatively. Risk factors for antibiotic resistance were also assessed.

Results. Of the 48 patients included in the study, urine and stone cultures did not reveal microflora growth in 26 (54.2%) patients. In the remaining 22 patients, we received different results: 1. only positive urine culture in 9 (18.8%) patients 2. only positive stone culture in 5 (10.4%) people 3. combination of positive bacteriological examination of urine and stone in 8 (16.7%) patients. Looking separately at 22 patients who had a positive urine or stone culture, or a combination of both, we noted that the combination of a positive urine culture with a positive stone culture and the combination of a positive urine culture with a negative stone culture were not significantly different and occurred in 36.4% and 40 .9% of cases, respectively, i.e. with a positive urine culture, there is an equal probability of about 40% of both an infected stone and a sterile one, while with a negative urine culture, an infected stone can occur in 22.7% of cases. In the early postoperative period, infectious complications were recorded in 3 (6.25%) patients. Complications were observed in 2 patients on the 4th day after surgery, and in one patient on the 2nd day. All three cases were postoperative pyelonephritis.

Conclusions. Our small study demonstrated the importance of culture in planning surgical treatment for urolithiasis. And further study of bacteriological studies of urine before surgery, urine obtained from the renal pelvis intraoperatively, and stones represents new directions for creating algorithms for monitoring patients with urolithiasis, predicting complications in the postoperative period, as well as local protocols for perioperative antibiotic prophylaxis and antibacterial therapy for patients with urolithiasis.