Intraoperative stone culture for tubeless minipercutaneous nephrolithotomy

Purpose: The aim of this study was to evaluate patients undergoing tubeless minipercutaneous nephrolithotomy (mini-PCNL) to assess the precision of preoperative urine culture and intraoperative stone culture in identifying individuals at risk for postoperative infectious complications. Materials and methods: Between March 2019 and March 2023, we retrospectively evaluated 264 patients undergoing tubeless mini-PCNL. Factors such as preoperative urine culture, stone burden and location, operative time, residual stone size, stone culture, stone analysis, and postoperative complications, including transfusion rate, febrile urinary tract infection, sepsis, and septic shock, were considered. Results: The positive urine culture rate was 55.89% and the positive intraoperative stone culture rate was 34.50%. A total of 18.94% of patients experienced complications. Among them, 9.09% developed febrile urinary tract infections, 3.03% experienced sepsis, and 4.55% went into shock. Univariate analysis identified female sex, old age, positive urine culture, and positive stone culture as significant risk factors for postoperative infections. A multivariate analysis revealed a substantial increase in the risk of septic shock by 5.09 times when a positive stone culture was present (odds ratio: 5.09; 95% CI: 1.22–21.16, P = 0.025). The positive stone culture rates for ammonium phosphate and calcium phosphate components were notably high, with percentages of 72.97% and 88.89%, respectively. Conclusion: This study demonstrated a significant correlation between stone culture and the occurrence of postoperative septic shock. We recommend the routine use of intraoperative stone culture to facilitate subsequent bacterial identification and antibiotic usage.