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Lionet A, Roger C, Biardeau X, Daudon M, Letavernier E. Chronic urine acidification by fludrocortisone to treat infectious kidney stones. CR CHIM 2022. [DOI: 10.5802/crchim.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Memmos D, Mykoniatis I, Sountoulides P, Anastasiadis A, Pyrgidis N, Greco F, Cindolo L, Hatzichristou D, Liatsikos E, Kallidonis P. Evaluating the usefulness of antibiotic prophylaxis prior to ESWL in patients with sterile urine: a systematic review and meta-analysis. Minerva Urol Nephrol 2020; 73:452-461. [PMID: 33200902 DOI: 10.23736/s2724-6051.20.04061-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The aim of this review is to evaluate the effect of antibiotic prophylaxis (AP) on asymptomatic bacteriuria (AB) and urinary tract infection (UTI) in patients with sterile urine undergoing ESWL. EVIDENCE ACQUISITION PubMed, Scopus, Web of Science and Cochrane Registry were searched systematically for randomized clinical trials assessing the effect of AP in patients with sterile urine undergoing SWL up to May 2020. Risk ratios were used to compare dichotomous outcomes. A stratified analysis was performed depending on the risk of bias assessment of the included studies. Subgroup analysis was performed in patients that underwent instrumentation of the urinary tract. EVIDENCE SYNTHESIS Sixteen studies were evaluated including 2442 patients. When evaluating all the included studies (regardless of the risk of bias assessment), the risk of AB was RR: 0.88, 95% CI: 0.64-1.21, P=0.42 and the risk of UTI was RR: 0.55, 95% CI: 0.22-1.36, P=0.19. When excluding the high risk of bias studies, the risk for AB was RR: 0.9, 95% CI: 0.63-1.28, P=0.55 and for UTI RR: 1.18, 95% CI: 0.38-3.72, P=0.77. When evaluating patients that underwent instrumentation of the urinary tract the risk for AB was RR: 0.92, 95% CI: 0.66-1.27, P=0.6 and for UTI was RR: 0.69, 95% CI: 0.22-2.22, P=0.54. CONCLUSIONS AP is not necessary for patients with sterile urine prior to ESWL for the prevention of UTI. Also, patients that undergo instrumentation of the urinary tract prior to or during ESWL do not benefit from antibiotic prophylaxis but further research is required.
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Affiliation(s)
- Dimitrios Memmos
- First Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Mykoniatis
- First Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Petros Sountoulides
- First Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece -
| | | | - Nikolaos Pyrgidis
- First Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Luca Cindolo
- Department of Urology, Villa Stuart Private Hospital, Rome, Italy
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Cetin N, Gencler A, Kavaz Tufan A. Risk factors for development of urinary tract infection in children with nephrolithiasis. J Paediatr Child Health 2020; 56:76-80. [PMID: 31090155 DOI: 10.1111/jpc.14495] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/02/2019] [Accepted: 04/29/2019] [Indexed: 11/28/2022]
Abstract
AIM Nephrolithiasis is one of the causes of urinary tract infection (UTI). In this study, we investigated risk factors for UTI in children with nephrolithiasis. METHODS The data from the patients with nephrolithiasis were evaluated in this retrospective follow-up study. Patients with a history of UTI before admission and congenital anomaly of kidney or urinary tract were excluded. The patients were divided into two groups: patients with UTI (recurrent UTI and single UTI) and patients without UTI. RESULTS A total of 599 patients were included in this study. UTI occurred in 181 (30.2%) patients. There was a positive association between the size of stone and UTI (odds ratio (OR): 1.355, P = 0.007). Receiver operating characteristic curve analysis showed that the cut-off value of the size of stone for UTI was 5.3 mm, with a sensitivity of 74.9% and a specificity of 66.1% (area under the curve: 0.572 ± 0.028, P = 0.013). The presence of a metabolic risk factor and age at diagnosis under 2 years were significantly associated with both UTI and recurrence of UTI (OR: 2.272, P = 0.021, OR: 1.809, P = 0.028, respectively, for metabolic risk factor; OR: 1.212, P = 0.041, OR: 1.122, P = 0.046, respectively, for age at diagnosis under 2 years). Hypercalciuria was significantly associated with the recurrence of UTI (OR: 1.854, P = 0.017). CONCLUSIONS The age at diagnosis, the presence of a metabolic risk factor and size of stone are significant risk factors for UTI in children with nephrolithiasis. The patients with idiopathic hypercalciuria, metabolic risk factor and age at diagnosis under 2 years have increased risk of recurrence of UTI.
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Affiliation(s)
- Nuran Cetin
- Department of Pediatric Nephrology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Aylin Gencler
- Department of Pediatric Nephrology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Aslı Kavaz Tufan
- Department of Pediatric Nephrology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
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Yongzhi L, Shi Y, Jia L, Yili L, Xingwang Z, Xue G. Risk factors for urinary tract infection in patients with urolithiasis-primary report of a single center cohort. BMC Urol 2018; 18:45. [PMID: 29783970 PMCID: PMC5963162 DOI: 10.1186/s12894-018-0359-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/03/2018] [Indexed: 01/08/2023] Open
Abstract
Background Urinary tract infection (UTI) is very common in patients with urolithiasis, which makes the treatment of urolithiasis complicated, even dangerous. The objective of this study was to determine the risk factors for UTI in patients with urolithiasis. Methods Eight hundred six patients with urolithiasis were retrospectively evaluated in the fourth affiliated hospital of China Medical University. All patients admitted to the study were divided into either a UTI infection group or a non-infection group. Sex, age, smoking, stone shape, alcohol consumption, position of stones, and presence of obstruction were used as exposure factors for the cross-sectional study. Results One hundred seventy-eight patients (22.0%) had UTI. Through a urine culture test, gram-negative bacilli were the most common pathogen, followed by gram-positive bacilli and fungi. Conclusions Sex, age, obstruction, stone shape, and multiple sites of stones could be considered the independent factors for UTI in patients with urolithiasis; smoking and drinking had no statistically significant correlation with the condition. Gram-negative bacilli are the most common pathogen in UTI in patients with urolithiasis.
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Affiliation(s)
- Li Yongzhi
- Department of Urology, Urologic Minimally Invasive Treatment Center in Liaoning Province, The Fourth Affiliated Hospital of China Medical University, No4, Chongshan East Road, Shenyang, 110032, China
| | - Yan Shi
- Department of Urology, Sheyang Red Cross Hospital, No4, Chongshan East Road, Huanggu District, Shenyang, 110032, China
| | - Liu Jia
- Department of Urology, Urologic Minimally Invasive Treatment Center in Liaoning Province, The Fourth Affiliated Hospital of China Medical University, No4, Chongshan East Road, Shenyang, 110032, China
| | - Liu Yili
- Department of Urology, Urologic Minimally Invasive Treatment Center in Liaoning Province, The Fourth Affiliated Hospital of China Medical University, No4, Chongshan East Road, Shenyang, 110032, China.
| | - Zhu Xingwang
- Department of Urology, Urologic Minimally Invasive Treatment Center in Liaoning Province, The Fourth Affiliated Hospital of China Medical University, No4, Chongshan East Road, Shenyang, 110032, China
| | - Gong Xue
- Department of Urology, Urologic Minimally Invasive Treatment Center in Liaoning Province, The Fourth Affiliated Hospital of China Medical University, No4, Chongshan East Road, Shenyang, 110032, China
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5
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Antibiotic use and the prevention and management of infectious complications in stone disease. World J Urol 2017; 35:1369-1379. [DOI: 10.1007/s00345-017-2005-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/10/2017] [Indexed: 11/26/2022] Open
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Sharma NL, Alexander CE, Grout E, Turney BW. Shock-wave lithotripsy: variance within UK practice. Urolithiasis 2016; 45:193-201. [PMID: 27216432 DOI: 10.1007/s00240-016-0886-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 02/24/2016] [Indexed: 11/24/2022]
Abstract
The objectives of this study are to determine the current treatment policies of UK shock-wave lithotripsy centres. Fixed-site lithotripter centres in the UK were identified via the national Therapeutic Interventions for Stones of the Ureter (TISU) study (n = 25). Questionnaires were completed regarding current SWL protocols for each centre, including management of anticoagulation, use of antibiotics and analgesia, urine testing, pacemakers, and arterial aneurysms. Data were collected regarding service delivery. Responses were obtained for 21 centres. Most centres use the Storz Modulith (85.7 %). Wide variation was observed in clinical contraindications to SWL, with 47.6 % centres performing SWL in patients with an abdominal aortic aneurysm, 66.7 % performing SWL in patients with a pacemaker, and 66.7 % of centres not performing SWL in asymptomatic patients with a urine dipstick positive for nitrites and leucocytes. The management of anticoagulation pre- and post-SWL showed wide variation, with the omission of anticoagulation ranging from 0 to 10 days pre-SWL. Seventeen distinct analgesia regimens were reported and prophylactic antibiotics are routinely administered in 25.0 % of centres. Tamsulosin is prescribed to all patients in 20.0 % of centres and a further 15.0 % of centres routinely prescribe tamsulosin post-SWL of ureteric stones. The included centres undertake SWL a median of 4 days per week and treat a median of six patients per list. Emergency SWL is unavailable in 30.0 % of centres. This observational real-life study has identified a significant disparity in the delivery of SWL throughout the UK, despite high numbers of patients with renal and ureteric stones being treated with this modality. Further studies should address the key areas of controversy, including an assessment of technical training, and facilitate the development of national guidelines to ensure a high level of standardized care for SWL patients.
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Affiliation(s)
- N L Sharma
- Oxford Stone Group, Department of Urology, Nuffield Department of Surgical Sciences, Oxford University Hospitals NHS Trust, Oxford, UK.
| | - C E Alexander
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | - E Grout
- Oxford Stone Group, Department of Urology, Nuffield Department of Surgical Sciences, Oxford University Hospitals NHS Trust, Oxford, UK
| | - B W Turney
- Oxford Stone Group, Department of Urology, Nuffield Department of Surgical Sciences, Oxford University Hospitals NHS Trust, Oxford, UK
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Abstract
The essential value of antimicrobial prophylaxis is to defend the patient undergoing invasive diagnostic procedures or surgery against infectious complications by reducing the bacterial load. Escherichia coli remains the predominant uropathogen (70-80%) isolated in acute community-acquired uncomplicated infections, followed by Staphylococcus saprophyticus (10 to 15%). Klebsiella, Enterobacter, Proteus species, and enterococci infrequently cause uncomplicated cystitis and pyelonephritis. The pathogens traditionally associated with UTI are altering many of their features, particularly because of antimicrobial resistance. Currently, only transurethral resection of prostate and prostate biopsy has been well studied and has high and moderately high levels of evidence in favor of using antibiotic prophylaxis. Other urological interventions have not been well studied. The moderate to low evidence suggests that there is no need for antibiotic prophylaxis in cystoscopy, urodynamic investigations, and extracorporeal shock-wave lithotripsy, whereas the low evidence favors the use of antibiotic prophylaxis for therapeutic ureterorenoscopy and percutaneous nephrolithotomy. The scarce data from studies on transurethral resection of bladder tumors cannot provide a definitive indication for antibiotic prophylaxis for this intervention.
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Mrkobrada M, Ying I, Mokrycke S, Dresser G, Elsayed S, Bathini V, Boyce E, Luke P. CUA Guidelines on antibiotic prophylaxis for urologic procedures. Can Urol Assoc J 2015; 9:13-22. [PMID: 25737749 DOI: 10.5489/cuaj.2382] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Marko Mrkobrada
- Department of Medicine, Schulich School of Medicine, London Health Science Centre, London, ON
| | - Ivan Ying
- Department of Medicine, Schulich School of Medicine, London Health Science Centre, London, ON
| | - Stephanie Mokrycke
- Department of Medicine, Schulich School of Medicine, London Health Science Centre, London, ON
| | - George Dresser
- Department of Medicine, Schulich School of Medicine, London Health Science Centre, London, ON
| | - Sameer Elsayed
- Department of Medicine, Schulich School of Medicine, London Health Science Centre, London, ON
| | - Varunkumar Bathini
- Department of Surgery, Schulich School of Medicine, London Health Science Centre, London, ON
| | - Erin Boyce
- Department of Medicine, Schulich School of Medicine, London Health Science Centre, London, ON
| | - Patrick Luke
- Department of Surgery, Schulich School of Medicine, London Health Science Centre, London, ON
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[Antibiotic prophylaxis in urology]. Urologia 2014; 81:209-17. [PMID: 25532466 DOI: 10.5301/uro.5000098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2014] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Antibiotic prophylaxis (AP) is used to minimize infectious complications resulting from interventions. Due to high rates of development of bacterial resistance and side effects, the use of antibiotics must be weighed on the basis of high levels of evidence. The main endpoints of urology AP are the prevention of symptomatic urogenital infections, urosepsis and wound infections. The purpose of this review is to bring objectives, principles and recommendations on urology AP according to the latest scientific evidence. METHODS We carried out a systematic search of MEDLINE, EMBASE and the Cochrane Library using keywords such as AP, prophylaxis, antibiotics, urological surgery, urogenital surgery and the names of the urologic procedures. The results of studies on the AP for each procedure were classified according to the levels of evidence and grades of recommendation from the European Association of Urology. RESULTS There are a number of good quality studies on AP about endoscopic resection of the prostate (TURP), urodynamic studies and transrectal prostate biopsies (trPB). The majority of the studies about other procedures have several limitations (sample size, consistency of definitions, statistics and trial design). Lack of consistency in the definitions of infectious complications does not allow comparison between different studies. CONCLUSIONS The AP is evidence-based is indicated only for TURP and trPB. It is desirable to perform randomized, prospective and controlled trials in order to rationalize the use of antibiotics, improve the cost/benefit ratio and reduce bacterial antibiotic resistances.
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Abstract
There are specific indications in urological procedures [transurethral resection of the prostate (TURP), transurethral resection of the bladder (TURB), endoscopic procedures, and all interventions classified as contaminated or dirty] requiring antibiotic prophylaxis. Most postoperative infections are caused by enterococci of the Gram-positive strains and Enterobacteriaceae of the Gram-negative ones. As reported by the European Center for Disease Prevention and Control (ECDC), there are increasing numbers of antibiotic-resistant pathogens. Most Enterococcus faecium strains are ampicillin-resistant and the Enterobacteriaceae have a high prevalence of extended-spectrum beta-lactamase (ESBL) producers, for which the cephalosporins and penicillins are not drugs of choice. In recent years, there are also increasing numbers of Gram-negative strains that are able to produce carbapenemases and for which the only therapeutic options are gentamicin, tigecycline and colistin. An alternative to these drugs, from a prophylactic point of view, is fosfomycin, an old antibiotic that maintains bactericidal activity against both enterococci and multidrug-resistant Enterobacteriaceae. Available in an oral formulation as trometamol salt, fosfomycin reaches high plasma and urine concentrations, and is therefore a possible alternative to other drugs both for therapy and urological prophylaxis.
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Mira Moreno A, Montoya Lirola MD, García Tabar PJ, Galiano Baena JF, Tenza Tenza JA, Lobato Encinas JJ. Incidence of infectious complications after extracorporeal shock wave lithotripsy in patients without associated risk factors. J Urol 2014; 192:1446-9. [PMID: 24866598 DOI: 10.1016/j.juro.2014.05.091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE We determined the incidence of infectious complications (asymptomatic bacteriuria, urinary tract infection and urosepsis) in patients without associated risk factors treated with extracorporeal shock wave lithotripsy. MATERIALS AND METHODS We performed an observational, prospective cohort study between October 2010 and June 2013. We included all patients without risk factors who were treated with extracorporeal shock wave lithotripsy for kidney or ureteral lithiasis. All patients underwent urine culture 5 days before the procedure. Another urine culture was performed 7 days after lithotripsy. No patient received antibiotics. RESULTS Initially 366 patients with a mean ± SD age of 53 ± 13 years were enrolled in the study. A total of 64 patients (17.5%) underwent extracorporeal shock wave lithotripsy with a previously placed Double-J® stent. After lithotripsy urine culture was positive in 20 patients (5.8%), of whom 4 (1.2%) presented with symptomatic urinary infection and the remaining 4.6% showed no symptoms. Urosepsis did not develop in any case. In our study patient age was an independent risk factor for bacteriuria after lithotripsy. CONCLUSIONS The incidence of infectious complications after extracorporeal shock wave lithotripsy in patients without risk factors is low. This leads us to conclude that without defined risk factors antibiotic prophylaxis is not justified. Also, elderly patients were more at risk for bacteriuria after extracorporeal shock wave lithotripsy and, thus, for a possible infectious complication.
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Flannigan R, Choy WH, Chew B, Lange D. Renal struvite stones--pathogenesis, microbiology, and management strategies. Nat Rev Urol 2014; 11:333-41. [PMID: 24818849 DOI: 10.1038/nrurol.2014.99] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Infection stones-which account for 10-15% of all urinary calculi-are thought to form in the presence of urease-producing bacteria. These calculi can cause significant morbidity and mortality if left untreated or treated inadequately; optimal treatment involves complete stone eradication in conjunction with antibiotic therapy. The three key principles of treating struvite stones are: removal of all stone fragments, the use of antibiotics to treat the infection, and prevention of recurrence. Several methods to remove stone fragments have been described in the literature, including the use of urease inhibitors, acidification therapy, dissolution therapy, extracorporeal shockwave lithotripsy, ureteroscopy, percutaneous nephrolithotomy (PCNL), and anatrophic nephrolithotomy. PCNL is considered to be the gold-standard approach to treating struvite calculi, but adjuncts might be used when deemed necessary. When selecting antibiotics to treat infection, it is necessary to acquire a stone culture or, at the very least, urine culture from the renal pelvis at time of surgery, as midstream urine cultures do not always reflect the causative organism.
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Affiliation(s)
- Ryan Flannigan
- The Stone Centre at Vancouver General Hospital, Jack Bell Research Centre, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada
| | - Wai Ho Choy
- The Stone Centre at Vancouver General Hospital, Jack Bell Research Centre, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada
| | - Ben Chew
- The Stone Centre at Vancouver General Hospital, Jack Bell Research Centre, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada
| | - Dirk Lange
- The Stone Centre at Vancouver General Hospital, Jack Bell Research Centre, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada
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D'A. Honey RJ, Ordon M, Ghiculete D, Wiesenthal JD, Kodama R, Pace KT. A Prospective Study Examining the Incidence of Bacteriuria and Urinary Tract Infection After Shock Wave Lithotripsy with Targeted Antibiotic Prophylaxis. J Urol 2013; 189:2112-7. [DOI: 10.1016/j.juro.2012.12.063] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2012] [Indexed: 10/27/2022]
Affiliation(s)
- R. John D'A. Honey
- Division of Urology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michael Ordon
- Division of Urology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Daniela Ghiculete
- Division of Urology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Joshua D. Wiesenthal
- Division of Urology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ronald Kodama
- Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kenneth T. Pace
- Division of Urology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Lu Y, Tianyong F, Ping H, Liangren L, Haichao Y, Qiang W. Antibiotic Prophylaxis for Shock Wave Lithotripsy in Patients with Sterile Urine Before Treatment May be Unnecessary: A Systematic Review and Meta-Analysis. J Urol 2012; 188:441-8. [PMID: 22704118 DOI: 10.1016/j.juro.2012.04.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Indexed: 02/05/2023]
Affiliation(s)
- Yang Lu
- Department of Urology, West China Hospital, Sichuan University, Sichuan, China
| | - Fan Tianyong
- Department of Urology, West China Hospital, Sichuan University, Sichuan, China
| | - Han Ping
- Department of Urology, West China Hospital, Sichuan University, Sichuan, China
| | - Liu Liangren
- Department of Urology, West China Hospital, Sichuan University, Sichuan, China
| | - Yuan Haichao
- Department of Urology, West China Hospital, Sichuan University, Sichuan, China
| | - Wei Qiang
- Department of Urology, West China Hospital, Sichuan University, Sichuan, China
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D'Addessi A, Vittori M, Racioppi M, Pinto F, Sacco E, Bassi P. Complications of extracorporeal shock wave lithotripsy for urinary stones: to know and to manage them-a review. ScientificWorldJournal 2012; 2012:619820. [PMID: 22489195 PMCID: PMC3317539 DOI: 10.1100/2012/619820] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 12/05/2011] [Indexed: 01/11/2023] Open
Abstract
To identify the possible complications after extracorporeal shock wave lithotripsy (SWL) and to suggest how to manage them, the significant literature concerning SWL treatment and complications was analyzed and reviewed. Complications after SWL are mainly connected to the formation and passage of fragments, infections, the effects on renal and nonrenal tissues, and the effects on kidney function. Each of these complications can be prevented adopting appropriate measures, such as the respect of the contraindications and the recognition and the correction of concomitant diseases or infection, and using the SWL in the most efficient and safe way, tailoring the treatment to the single case. In conclusion, SWL is an efficient and relatively noninvasive treatment for urinary stones. However, as with any other type of therapy, some contraindications and potential complications do exist. The strictness in following the first could really limit the onset and danger of the appearance of others, which however must be fully known so that every possible preventive measure be implemented.
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Affiliation(s)
- Alessandro D'Addessi
- Department of Urology, Catholic University School of Medicine, Policlinico "A. Gemelli", Largo F. Vito, 00168 Rome, Italy.
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Grabe M. Antibiotic prophylaxis in urological surgery, a European viewpoint. Int J Antimicrob Agents 2011; 38 Suppl:58-63. [DOI: 10.1016/j.ijantimicag.2011.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Grabe M, Botto H, Cek M, Tenke P, Wagenlehner FME, Naber KG, Bjerklund Johansen TE. Preoperative assessment of the patient and risk factors for infectious complications and tentative classification of surgical field contamination of urological procedures. World J Urol 2011; 30:39-50. [PMID: 21779836 DOI: 10.1007/s00345-011-0722-z] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 06/14/2011] [Indexed: 12/21/2022] Open
Affiliation(s)
- Magnus Grabe
- Department of Urology, Skåne University Hospital, S-20502, Malmö, Sweden.
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Lorber G, Duvdevani M, Gofrit ON, Latke A, Katz R, Landau EH, Meretyk S, Pode D, Shapiro A. What Happened to Shockwave Lithotripsy During the Past 22 Years? A Single-Center Experience. J Endourol 2010; 24:609-14. [DOI: 10.1089/end.2009.0152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Gideon Lorber
- Department of Urology, Hadassah Hebrew University Hospital (Ein-Karem), Jerusalem, Israel
| | - Mordechai Duvdevani
- Department of Urology, Hadassah Hebrew University Hospital (Ein-Karem), Jerusalem, Israel
| | - Ofer N. Gofrit
- Department of Urology, Hadassah Hebrew University Hospital (Ein-Karem), Jerusalem, Israel
| | - Arie Latke
- Department of Urology, Hadassah Hebrew University Hospital (Ein-Karem), Jerusalem, Israel
| | - Ran Katz
- Department of Urology, Hadassah Hebrew University Hospital (Ein-Karem), Jerusalem, Israel
| | - Ezekiel H. Landau
- Department of Urology, Hadassah Hebrew University Hospital (Ein-Karem), Jerusalem, Israel
| | - Shimon Meretyk
- Department of Urology, Hadassah Hebrew University Hospital (Ein-Karem), Jerusalem, Israel
| | - Dov Pode
- Department of Urology, Hadassah Hebrew University Hospital (Ein-Karem), Jerusalem, Israel
| | - Amos Shapiro
- Department of Urology, Hadassah Hebrew University Hospital (Ein-Karem), Jerusalem, Israel
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Duvdevani M, Lorber G, Gofrit ON, Latke A, Katz R, Landau EH, Meretyk S, Shapiro A, Pode D. Fever After Shockwave Lithotripsy—Risk Factors and Indications for Prophylactic Antimicrobial Treatment. J Endourol 2010; 24:277-81. [DOI: 10.1089/end.2009.0283] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mordechai Duvdevani
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Gideon Lorber
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Ofer N. Gofrit
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Arie Latke
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Ran Katz
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Ezekiel H. Landau
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Shimon Meretyk
- Department of Urology, Rambam Medical Center, Haifa, Israel
| | - Amos Shapiro
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Dov Pode
- Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel
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20
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Complications and outcomes following extracorporeal shock wave lithotripsy: a prospective study of 3,241 patients. ACTA ACUST UNITED AC 2009; 38:135-42. [PMID: 20016885 DOI: 10.1007/s00240-009-0247-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Accepted: 11/27/2009] [Indexed: 01/08/2023]
Abstract
Extracorporeal shock wave lithotripsy (SWL) has become the least invasive treatment modality with high success rates for urinary calculi; however, its established efficacy has been associated with a number of side effects and complications. This study sought to further evaluate the incidence rate and management of the post-SWL complications and also the efficiency of procedure in a large scale of patients. During a 51-month period, 3,241 consecutive adult patients with the mean age of 38.1 years (range 15-75) and urinary calculi (>or=4 mm) underwent SWL at our referral center and were followed for 3 months prospectively. Overall, 3,614 stones [kidneys (83.5%), ureters (15.8%) and bladder (0.7%)] in 3,241 patients were treated requiring 7,245 SWL sessions. Stone-free state occurred in 71.5% calculi and success rate in 79.8% patients. The re-treatment was necessary in 37.2% patients. Auxiliary procedure and efficiency quotient were 5.6% and 0.50, respectively. SWL success rate decreased as the stone size increased (P < 0.0001). The stone-free rate was correlated with the location of the stone. During the study period, 4,075 complications occurred in our patients. Colicky pain (40%) was the most frequent symptom followed by gross hematuria (32%) and steinstrasse (24.2%). Symptomatic bacteriuria developed in 9.7% patients; Escherichia coli (30.4%) was the most causative organism. In conclusion, the complication rate following SWL was high in our study; however, the majority was mild and managed conservatively or with the minimal intervention. Moreover, the management of urinary calculi in adults using SWL was proved to be safe and efficient, particularly for ureteral stones <10 mm, renal pelvic stones <20 mm, and bladder stones <30 mm.
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21
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Ordon M, Kodama R, Honey RJD. Re: Best practice policy statement on urologic surgery antimicrobial prophylaxis. J. S. Wolf, Jr., C. J. Bennett, R. R. Dmochowski, B. K. Hollenbeck, M. S. Pearle and A. J. Schaeffer. J Urol 2008; 179: 1379-1390. J Urol 2009; 182:799-800; author reply 800-1. [PMID: 19540529 DOI: 10.1016/j.juro.2009.04.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Indexed: 11/29/2022]
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22
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Bootsma AMJ, Laguna Pes MP, Geerlings SE, Goossens A. Antibiotic prophylaxis in urologic procedures: a systematic review. Eur Urol 2008; 54:1270-86. [PMID: 18423974 DOI: 10.1016/j.eururo.2008.03.033] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Accepted: 03/11/2008] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Antibiotic prophylaxis is used to minimize infectious complications resulting from interventions. Side-effects and development of microbial resistance patterns are risks of the use of antibiotics. Therefore, the use should be well considered and based on high levels of evidence. In this review, all available evidence on the use of antibiotic prophylaxis in urology is gathered, assessed, and presented in order to make choices in the use of antibiotic prophylaxis on the best evidence currently available. METHODS A systematic literature review was conducted, searching Medline, Embase (1980-2006), the Cochrane Library, and reference lists for relevant studies. All selected articles were reviewed independently by two, and, in case of discordance, three, reviewers. RESULTS Only the transurethral resection of prostate (TURP) and prostate biopsy are well studied and have a high and moderate to high level of evidence in favour of using antibiotic prophylaxis. Other urologic interventions are not well studied. The moderate to low evidence suggests no need for antibiotic prophylaxis in cystoscopy, urodynamic investigation, transurethral resection of bladder tumor, and extracorporeal shock-wave lithotripsy, whereas for therapeutic ureterorenoscopy and percutaneous nephrolithotomy, the low evidence favours the use of antibiotic prophylaxis. Urologic open and laparoscopic interventions were classified according to surgical wound classification, since no studies were identified. Antibiotic prophylaxis is not advised in clean surgery, but is advised in clean-contaminated and prosthetic surgery. CONCLUSIONS Except for the TURP and prostate biopsy, there is a lack of well-performed studies investigating the need for antibiotic prophylaxis in urologic interventions.
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Affiliation(s)
- A M Jikke Bootsma
- Department of Urology, Academic Medical Center, University of Amsterdam, The Netherlands
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23
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Matsumoto T, Kiyota H, Matsukawa M, Yasuda M, Arakawa S, Monden K. Japanese guidelines for prevention of perioperative infections in urological field. Int J Urol 2007; 14:890-909. [PMID: 17880286 DOI: 10.1111/j.1442-2042.2007.01869.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
For urologists, it is very important to master surgical indications and surgical techniques. On the other hand, the knowledge of the prevention of perioperative infections and the improvement of surgical techniques should always be considered. Although the prevention of perioperative infections in each surgical field is a very important issue, the evidence and the number of guidelines are limited. Among them, the preparation of guidelines has progressed, especially in gastrointestinal surgery. The Center for Disease Control and Prevention (CDC) proposed guidelines for the prevention of surgical site infections, which have been used worldwide. In urology, the original guidelines were different from those of general surgery, due to many endourological procedures and urine exposure in the surgical field. The Japanese Society of UTI Cooperative Study Group has thus framed these guidelines supported by The Japanese Urological Association. The guidelines consist of the following nine techniques: open surgeries, laparoscopic surgeries, transurethral resection of bladder tumor, ureterorenoscope and transurethral lithotripsy, transurethral resection of the prostate, prostate biopsy, cystourethroscope, pediatric surgeries in the urological field, and extracorporeal shock wave lithotripsy and febrile neutropenia. These are the first guidelines for the prevention of perioperative infections in the urological field in Japan. Although most of these guidelines were made using reliable evidence, there are parts without enough evidence. Therefore, if new reliable data is reported, it will be necessary for these guidelines to be revised in the future.
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Affiliation(s)
- Tetsuro Matsumoto
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan.
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Argyropoulos AN, Tolley DA. Optimizing Shock Wave Lithotripsy in the 21st Century. Eur Urol 2007; 52:344-52. [PMID: 17499914 DOI: 10.1016/j.eururo.2007.04.066] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Accepted: 04/20/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Shock wave lithotripsy (SWL) has radically changed treatment of stone disease and appears to be the first option for the majority of patients. This review of current literature focused on suggestions for optimising technique, patient selection, results, and lithotriptor comparison for SWL. METHODS Literature search for SWL was performed for recently published papers in English language. Topics of interest were treatment protocols; patient evaluation; pre-SWL prediction of outcome; lithotriptor technology; efficacy; and methods to assess the effects, decrease complications, and compare lithotriptors. Earlier classic papers on SWL and guidelines for stone disease were also reviewed. RESULTS Recent literature contained important recommendations about SWL concerning (1) methods to predict stone fragmentation; (2) identification of factors contributing to treatment failure for lower pole and ureteric calculi; (3) guidelines from urological associations; (4) manoeuvres and changes in SWL delivery (slower rate, twin-pulse technique) to increase efficacy and decrease complications; (5) clarification of the role of medical treatment (antibiotics, alpha-blockers); (6) role of SWL in calyceal stones, CIRF, and abnormal kidneys; (7) obesity and SWL; and (8) methods to evaluate and compare lithotriptors. CONCLUSIONS SWL delivered in an outpatient setting as an anaesthesia-free treatment is still considered the first option for the majority of stones with a minimal number of complications. Better understanding of the physics of shockwave delivery is required, together with treatment optimisation by limiting renal damage and better selection of patients because this approach will offer maximum benefit to patients and physicians, as well as more cost-effective treatment.
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25
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Skolarikos A, Alivizatos G, de la Rosette J. Extracorporeal shock wave lithotripsy 25 years later: complications and their prevention. Eur Urol 2006; 50:981-90; discussion 990. [PMID: 16481097 DOI: 10.1016/j.eururo.2006.01.045] [Citation(s) in RCA: 185] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2005] [Accepted: 01/30/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We review the pathophysiology and possible prevention measures of complications after extracorporeal shock wave lithotripsy (ESWL). METHODS A literature search was performed with the Medline database on ESWL between 1980 and 2004. RESULTS ESWL application has been intuitively connected to complications. These are related mostly to residual stone fragments, infections, and effects on tissues such as urinary, gastrointestinal, cardiovascular, genital, and reproductive systems. Recognition of ESWL limitations, use of alternative therapies, correction of pre-existing renal or systemic disease, treatment of urinary tract infection, use of prophylactic antibiotics, and improvement of ESWL efficacy are the most important measures of prevention. Decrease of shock wave number, rate and energy, use of two shock-wave tubes simultaneously, and delivery of two shock waves at carefully timed close intervals improve ESWL efficacy and safety. CONCLUSION ESWL is a safe method to treat stones when proper indications are followed. The need for well-designed prospective randomised trials on aetiology and prevention of its complications arises through the literature review.
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Affiliation(s)
- Andreas Skolarikos
- Urology Department, Athens Medical School, Sismanoglio Hospital, Athens, Greece
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26
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Abstract
Since 1980, extra corporeal shock wave lithotripsy (ESWL) has become the first line treatment for most stones in adults and children. The indications are based on criteria depending on localization, chemical composition and size of the renal and ureteral calculi. Since the DORNIER HM 3 which remains the gold standard of first generation lithotripters, many devices of second and third generation have been built (electro hydrolic, piezo electric and electromagnetic) with fluoroscopic and ultrasound localization systems. SWL may now be performed on an out-patient basis without anaesthesia or under neuroleptic analgesia. Indications and evaluation criteria on 3 months plain abdominal X-ray are better defined since 1996. Nevertheless, comparison of reported results remains difficult due to the multiplicity of lithotripter types and the lack of consensus on efficacy criteria. Today, the third generation of mobile electromagnetic lithotripters give an average of 80% stone free rate of patients with kidney and ureteral calculi whatever the localization and size.
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Affiliation(s)
- B Doré
- Service d'urologie, Pavilion C Guérin, CHU de Poitiers, La Milétrie, France.
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27
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Slavković A, Radovanović M, Sirić Z, Vlajković M, Stefanović V. Extracorporeal shock wave lithotripsy for cystine urolithiasis in children: outcome and complications. Int Urol Nephrol 2003; 34:457-61. [PMID: 14577484 DOI: 10.1023/a:1025694230131] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The Siemens Lithostar Litotriptor was used to treat 6 children with cystine nephrolithiasis, previously treated by open surgery. Five children had renal calculi (3 multiple caliceal, 2 pelvis) and one had ureteral calculus. Stone size ranged from 0.2-2.5 cm in diameter, and stone burden was from 0.24 to 10.81 cm3 per kidney. From one to 4 ESWL sessions per unit were applied, with a total of 1,800 to 12,000 shock waves. The stone free rate at 3 months was 50%. A complete elimination was obtained with cystine stones in renal pelvis and ureter, however, up to 4 ESWL treatments failed in caliceal stones. Rather location of cystine calculi than previous surgery was associated with ESWL success rate. Two patients with positive urine cultures were successfully treated with appropriate antibiotics before ESWL was attempted. Perirenal hematoma was major complication demonstrated by radionuclide scintigraphy in one patient, and resolved spontaneously by 3 months. In the combined treatment of cystine urolithiasis in children ESWL, as auxillary procedure, was safe and effective in pelvis stone but failed in caliceal stones. Medical dissolution for retained fragments was found effective.
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Qureshi F, Abdulmannan M, Al-Qahtani H, Gabr A. Screening for significant bacteriuria in patients with upper tract calculi using dipstick urine analysis. Ann Saudi Med 2002; 22:381-3. [PMID: 17146271 DOI: 10.5144/0256-4947.2002.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Farukh Qureshi
- Department of Urology, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia.
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29
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Dinzel C, Ozdiler E, Ozenci H, Tazici N, Kosar A. Incidence of Urinary Tract Infection in Patients Without Bacteriuria Undergoing SWL: Comparison of Stone Types. J Urol 1999. [DOI: 10.1016/s0022-5347(01)62026-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- C. Dinzel
- Department of Urology, University of Ankara School of Medicine, Ankara, Turkey
| | - E. Ozdiler
- Department of Urology, University of Ankara School of Medicine, Ankara, Turkey
| | - H. Ozenci
- Department of Urology, University of Ankara School of Medicine, Ankara, Turkey
| | - N. Tazici
- Department of Urology, University of Ankara School of Medicine, Ankara, Turkey
| | - A. Kosar
- Department of Urology, University of Ankara School of Medicine, Ankara, Turkey
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30
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Incidence of Urinary Tract Infection in Patients Without Bacteriuria Undergoing SWL. J Urol 1999. [DOI: 10.1097/00005392-199902000-00131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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31
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Literature Watch: 1997 (Part I). J Endourol 1998. [DOI: 10.1089/end.1998.12.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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