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Concurrent urinary tract infection and stone disease: pathogenesis, diagnosis and management

Abstract

Urinary tract stones and urinary tract infection are strongly associated. Infection is implicated as the cause of stones in about 15% of stone formers, and the development of infection can complicate the management of pre-existing stones. Left untreated, both situations can result in loss of kidney function, and can, on occasion, be life threatening. The underlying pathophysiology of infection stones is generally well understood, but factors dictating why a particular individual should be affected are less clear, although obstruction is a uniformly recognized risk factor. Surgery is the mainstay of treatment for infection calculi: stone clearance is the goal and a range of minimally invasive treatments is available. Systemic sepsis remains the most serious complication of treatment, and, although rare, still occurs despite antibiotic prophylaxis. Once the stone and the causative infection have been removed, various strategies can be employed to minimize the risk of recurrence. When infection complicates pre-existing stone disease, the primary aim of management is to treat the infective episode and delay definitive stone management until the infection has cleared. In such cases where obstruction is also present, prompt drainage of the affected kidney is likely to prevent permanent renal damage, and may be life saving.

Key Points

  • Urinary tract stones and urinary tract infections are strongly associated, and their co-occurrence can have serious health implications

  • The pathogenesis of stones as a consequence of urinary tract infection is generally well understood; however, the risk factors that predispose patients with urinary tract infection to develop stones are not well known

  • Infection stones usually present insidiously with recurrent infections and vague loin pain; diagnosis can be made on the basis of imaging studies and urinalysis

  • The treatment options for infection stones are similar to those for other urinary tract stones, but not all options are suitable for every patient, and treatment should be individualized

  • Potential methods for preventing stone recurrence in patients with infection include eradication and prevention of the infection, use of urease inhibitors, and acidification of the urine, although both urease inhibitors and local dissolution therapy can have adverse effects

  • Infection in patients with pre-existing stone disease can lead to life-threatening sepsis; prompt recognition and treatment of the infection is required, plus drainage of the kidney in cases of obstruction

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Figure 1: This diagram shows the key stages in the formation of infection stones.
Figure 2: This plain kidney–ureter–bladder radiograph shows two infection stones (arrows) on a patient's right side.

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Correspondence to Ben Thomas.

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Thomas, B., Tolley, D. Concurrent urinary tract infection and stone disease: pathogenesis, diagnosis and management. Nat Rev Urol 5, 668–675 (2008). https://doi.org/10.1038/ncpuro1254

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