Clinical significance of stone culture during endourological procedures in predicting post-operative urinary sepsis: should it be a standard of care-evidence from a systematic review and meta-analysis from EAU section of Urolithiasis (EULIS)

Purpose Urinary sepsis is the leading cause of mortality in the setting of endourological procedures for stone treatment such as URS and PCNL; renal stones themselves may be a source of infection. Aim of this study is to determine the diagnostic accuracy of stone cultures (SC) collected during URS and PCNL in predicting post-operative septic complications, compared to preoperative bladder urine culture (BUC). Methods We performed a systematic review (SR) of literature according to the PRISMA guidelines; Literature quality was evaluated according to The Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) assessment tool. A univariate meta-analysis (MA) was used to estimate pooled log odds ratio of BUC and SC, respectively. Results Overall, 14 studies including 3646 patients met the inclusion criteria. Eight studies reported data from PCNL only; three from URS only; three from both URS and PCNL. Stone cultures showed a higher sensitivity (0.52 vs 0.32) and higher positive predictive value (0.28 vs 0.21) in predicting post-operative sepsis, compared to bladder urine cultures. The pool-weighted logarithmic odd risk (LOR) for BUC was 2.30 (95% CI 1.51-3.49, p < 0.001); the LOR for stone cultures (SC) in predicting post-operative sepsis was 5.79 (95% CI 3.58-9.38, p < 0.001). Conclusion The evidence from this SR and MA suggests that intraoperative SC from stone fragments retrieved during endourological procedures are better predictors of the likelihood of occurrence of post-operative sepsis compared to pre-operative BUC. Therefore, SC should be a standard of care in patients undergoing endourological interventions.