Preoperative vs Intraoperative Cultures Predicting Post-PCNL Urinary Tract Infections
Overview
This study evaluated the predictive value of preoperative midstream urine culture (PMUC) versus intraoperative renal pelvic urine culture (RPUC) and stone culture (SC) for postoperative urinary tract infections (UTIs) following supine percutaneous nephrolithotomy (PCNL). Among 234 patients, postoperative UTI incidence was 14.1%, with intraoperative cultures showing stronger associations with infection than PMUC.
Background
Percutaneous nephrolithotomy (PCNL) is the preferred treatment for large renal stones but carries a risk of postoperative infections, including fever and sepsis. Preoperative midstream urine cultures (PMUC) guide antibiotic prophylaxis, yet infections may still occur due to bacterial colonization within stones and increased intrapelvic pressure during surgery. Intraoperative cultures from renal pelvic urine and stone fragments may better identify causative pathogens and predict postoperative infectious complications, as supported by European Association of Urology guidelines.
Data Highlights
Parameter
UTI-Positive (n=33)
UTI-Negative (n=201)
p-value
Postoperative UTI incidence
14.1%
85.9%
-
Postoperative early fever
72.7%
3%
<0.001
ICU monitoring due to urosepsis
2.14%
0%
-
Female sex
60.6%
39.4%
0.001
ASA score 3
Higher proportion
Lower proportion
0.020
Key Findings
Postoperative UTI occurred in 14.1% of patients undergoing supine PCNL.
Intraoperative renal pelvic urine culture (RPUC) and stone culture (SC) were more reliable than preoperative midstream urine culture (PMUC) in predicting postoperative UTIs.
Female patients and those with higher ASA scores (3) had significantly higher rates of postoperative UTIs.
Postoperative fever was significantly more common in patients who developed UTIs (72.7% vs. 3%).
A small subset (2.14%) required ICU care due to urosepsis, with one mortality reported.
Clinical Implications
Intraoperative cultures (RPUC and SC) should be considered alongside preoperative urine cultures to better predict and manage postoperative infections after PCNL. Identifying patients at higher risk, such as females and those with elevated ASA scores, can guide more vigilant monitoring and tailored antibiotic strategies. Early detection and treatment of infections may reduce severe complications including sepsis and mortality.
Conclusion
Intraoperative renal pelvic urine and stone cultures provide superior predictive value for postoperative UTIs compared to preoperative midstream urine cultures in patients undergoing supine PCNL. Incorporating these cultures into clinical practice may improve infection management and patient outcomes.
References
European Association of Urology Guidelines 2025 -- Management of Renal Stones
Institutional Study 2020-2025 -- Evaluation of Preoperative versus Intraoperative Cultures in Predicting Postoperative UTIs After Supine PCNL
