Introduction
Infectious complications can often occur after surgery performed for the
treatment of upper urinary tract stones. Preoperative bladder urine
culture (PBUC) analysis has become a standard application before any
stone surgery. Previous studies have shown that a positive PBUC
indicates an increased possibility of postoperative infectious
complication development [1].It is contraindicated to perform
flexible ureterorenoscopy (f-URS) in the presence of a positive PBUC.
However, infectious complications can occur even in the presence of
prophylactic antibiotics and a negative PBUC [2]. It has been
reported that although perioperative antimicrobial prophylaxis (PAP) is
given after stone surgery, fever may develop in 4.4% and sepsis in
0.7% of patients [3]. In addition, infectious complications are
among the most feared complications after f-URS. Despite the application
of prophylactic antibiotherapy suitable for PBUC, infectious
complications after f-URS cannot be completely prevented.
The results of the PBUC susceptibility test do not correlate well with
the results of renal pelvic urine culture (RPUC) analysis [4]. It
has been demonstrated that growth in RPUC is an important marker for
infection development after endoscopic operations [5]. Despite
antibiotic treatment or PAP, growth may occur in cultures taken
intraoperatively, or postoperative urinary tract infection may develop
depending on factors such as obstruction and antimicrobial resistance in
the urinary system [6]. In addition, antibiotherapy applied as a
result of obstruction in the upper urinary system that can cause
hydronephrosis may lead to the incomplete destruction of bacteria and
increase bacterial resistance due to its insufficient efficacy [7].
If there is a bacterial focus in the upper urinary system and if this
can be predicted before the operation using any method, patients can be
treated with a more appropriate antibiotic or appropriate prophylaxis
before the intervention/operation. While the American Urological
Association (AUA) guidelines suggest that PAP should be applied to all
patients to reduce urosepsis after f-URS, the European Association of
Urology (EAU) recommends that it should only be given to patients with a
high risk of infection [8-10].However, PBUC may not fully reflect
the microbiological state in cases of upper urinary tract obstruction
[11]. Even if PBUC is negative, RPUC can be positive, especially in
the presence of upper urinary tract obstruction. It has been shown that
in patients undergoing percutaneous nephrolithotomy, RPUC and stone
culture taken during surgery can provide additional information for
treatment planning in those that develop an infection in the
postoperative period [12,13]. However, the role of cultures taken
during f-URS has not yet been fully revealed.
In this study, we evaluated the consistency between the results of PBUC
taken preoperatively and RPUC taken at the beginning of the f-URS
operation and to determine the predictability of a positive RPUC based
on associated preoperative markers.