TY  - CHAP
T1  - Infection induced urinary stones
T2  - Urogenital Infections and Inflammations
AU  - Strohmaier, Walter Ludwig
ED  - Naber, Kurt G.
AD  - Prof. Dr. Dr. Walter Ludwig Strohmaier FEBU, Regiomed-Klinikum Coburg. Medical School Regiomed, Urology and Paediatric Urology, Ketschendorfer Str. 33, 96450, Coburg, Germany, Phone: +49-9561-226301, E-mail: walter.strohmaier@klinikum-coburg.de
N2  - Stones composed of struvite, carbonate apatite and ammonium urate are regarded as induced by urinary tract infection (UTI) with bacteria producing the enzyme urease (mainly Proteus species) which splits urea into ammonium and carbonate ions resulting in supersaturation and alkalization of the urine. Struvite and apatite crystals form and grow to stones. Compared to other mineral types infection induced stones (IIS) represent only a small percentage of urinary stones. Nevertheless they deserve special attention. Due to the high recurrence rate, the risk for loss of renal function and recurrent UTI, patients with IIS are classified as high risk stone formers. IIS often form in patients with urinary obstruction, neurogenic bladder disorders, urinary diversion and indwelling catheters. The mainstay in laboratory diagnosis is urinalysis, urine culture with antibiogram and stone analysis. As IIS are regularly associated with UTI, fever at presentation is not uncommon. Then immediate imaging is required. Ultrasound of the urinary tract is the imaging modality to be used first, followed by non-contrast computerized tomography (NCCT). As in most IIS patients operative stone therapy is required, a contrast study is mandatory. Therefore, intravenous urography is also a viable option thus avoiding high radiation exposure associated with NCCT. If there is a septic obstruction caused by the stone, immediate relief is a must. The definite stone removal should be postponed until the sepsis is resolved. Since IIS often a large renal stones (>2 cm) or even complete or partial staghorn stone, the procedure of choice is mainly percutaneous nephrolithotomy, sometimes in combination with flexible scopes or shock wave lithotripsy. UTI must be treated prior to endourologic stone removal. In all patients, perioperative antibiotic prophylaxis is recommended. Specific metaphylaxis consists of removal of the stones as completely as possible, followed by antibiotic treatment (short or long term) and acidification of the urine (all these recommendations with a LE 3 and GR B).
PY  - 2018
DA  - 2018/02/27
DO  - 10.5680/lhuii000017
LA  - en
L1  - https://books.publisso.de/en/system/getFile/25
UR  - https://dx.doi.org/10.5680/lhuii000017
L2  - https://dx.doi.org/10.5680/lhuii000017
PB  - German Medical Science GMS Publishing House
CY  - Duesseldorf
ER  -