Bacteriuria and extracorporeal shock wave lithotripsy, prophylaxis and treatment
Extracorporeal shock wave lithotripsy (E.S.W.L.)have some serious complications. Among these, infectious complications are well known e.g. urosepsis , persistent bacteriuria & acute pyelonephritis. In this study we assessed pre-E.S.W.L. urinalysis (U/A) & urine culture (U/C) as predictors of infectious complications. During a 3 year period 2618 patients were treated for urinary tract calculi by Siemens Lithostar lithotriptor. All patients had a pre E.S.W.L. U/A & U/C according to which they were classified as follow: Group I : Normal U/A & U/C (1282 patients) Group II: Normal U/c , pyuria in U/A ( 1050 patients ) Grouplll:Positive U/C (286 patients ) Group 1 received no pre E.S.W.L. antibiotic; group II received either no treatment (lia 550 patients ) or a single dose of cephalosporine or gentamiclne before E.S.W.L. (lib 500 patients); group III either received a full course of antibiotic and E.S.W.L would be performed if U/C was negative after 7 days of treatment (Ilia 142 patients ) or received 7 days of antibiotic with E.S.w.Lcarrled on the 5th day regardless of U/C result (IIIb 144 patients). There was no difference in infectious complications between group I,lla and Mb. Group III had a significant rate of infectious complications with the serious ones occuring mainly in group 1IIb (2 cases of sepsis, 3 cases of pyelonephritis). U/A & U/C can aid the clinician to classify candidates of E.S.W.L. into high & low risk groups for infectious complications.Low risk patients need no antibiotic prophylaxis but in high risk patients bacteriuria should be eradicated before E.S.W.L. .