Stone culture, bladder or pelvic urine culture: the most helpful tool for an endourologist - a review of literature from EAU section of endourology.

purposeUrosepsis is a potential life-threatening complication of minimally invasive endourological procedures. High discordance rates exist between bladder urine cultures and cultures from the upper tract (renal pelvis and stones cultures). Aim of this systematic review is to summarise the evidence on the clinical value of pre-operative bladder urine culture (PBUC), renal pelvis urine culture (RPUC) and stone cultures (SC) in predicting post-operative infective complications after URS or PCNL.

methodsA systematic review was performed in accordance to the PRISMA guidelines. The PICO model of the clinical search question was: Patients - patients undergoing PCNL or URS; Intervention - intra-operative RPUC and SC; Comparison - compared to pre-operative BUC; Outcome - prediction of post-operative systemic inflammatory response syndrome (SIRS) or sepsis. Studies included were published between 2004 and 2024.

results21 studies were included. PBUC was shown to have a poor concordance rate with intra-operative cultures. PBUC had a lower value in predicting post-operative SIRS and sepsis compared to intra-operative cultures. A significant concordance rate was found between RPUC and SC. SC were the best predictors of the development of post-operative SIRS and urosepsis.

conclusionA pre-operative bladder urine culture is often not representative of the upper tract microbiological environment. Collecting renal pelvis urine cultures and stone cultures during RIRS and PCNL should be the standard of care, especially in high risk patients.