Endoscopic stone surgery: minimizing the risk of post-operative sepsis.
OBJECTIVE
Urosepsis from manipulation of the urinary tract during stone surgery can be catastrophic despite antibiotic prophylaxis and sterile pre-operative urine. We have reviewed recent literature with regards to pathogenesis, predictors of infected stones and prevention of urosepsis.


RESULTS
Bladder urine culture has been found to correlate poorly with infection in the upper urinary tract, defined by either stone or pelvic urine culture. This specimen, which has been the cornerstone in pre-operative preparation of patients, does not predict urosepsis. Authors recommending routine stone culture found that the presence of infected stones is highly predictive of potential sepsis. Terminology for systemic infection has been standardized and used in recent literature to define urosepsis.


CONCLUSIONS
Recent studies have recommended changes in the approach to the peri-operative management of stone surgery. Predictors of potential sepsis have also been identified.
Mariappan
Paramananthan
P
Department of Urology, Scottish Lithotriptor Centre, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, Scotland, UK. Param.Mariappan@luht.scot.nhs.uk
Tolley
David A
DA
D019072:Antibiotic Prophylaxis; D004724:Endoscopy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology* / Q000517:prevention & control*; D016482:Urinalysis; D014552:Urinary Tract Infections / Q000209:etiology* / Q000517:prevention & control*