Evaluation of the potential pathogenicity of microorganisms associated with urinary calculi.

Due to the prevalence of postoperative complications in the treatment of urolithiasis, the study of the contamination of urinary calculi and the potential pathogenicity of isolated bacteria is of great importance in laboratory diagnostic practice. It has been shown that uropathogenic bacteria are found in the composition of urinary stones in 65±7.1% of cases, mainly representatives of the Enterobacteriaceae and Staphylococcaceae families. Bacteria of the generas Escherichia, Enterococcus, Staphylococcus were most frequently detected. The analysis of biofilm activity and antibiotic resistance in 50 uropathogenic strains was carried out. It was shown that all the studied strains were resistant to at least two tested drugs, and the average value of the multiple resistance index was 0.51. When cultured on nutrient agar with Congo red, it was shown that more than half of the tested strains have high biofilm activity and about 80% potential for biofilm formation. The greatest biofilm activity was observed in bacteria of the generas Escherichia, Klebsiella, Enterobacter, Staphylococcus.

Controlled Fragmentation of Urinary Stones as a Method of Preventing Inflammatory Infections in the Treatment of Urolithiasis (Experience in Successful Clinical Use).

The introduction of technologically advanced methods of lithotripsy into medical practice changes the nature of postoperative complications. Among them, the main complications are inflammatory infections. This largely determines the search for new, improved methods of stone fragmentation avoiding small stone fragments and dissemination of the pelvicalyceal system of the kidney with stone-associated infection. The authors have developed a method for controlled stone fragmentation using a continuous-wave diode laser with a hot-spot effect at the optical fiber end. The aim of the study was to evaluate the efficacy of controlled urinary stone fragmentation using a continuous-wave diode laser with a highly heated distal end of the optical fiber light guide as a method of preventing inflammatory infections in clinical practice. MATERIALS AND METHODS: We analyzed 1666 case histories of urolithiasis patients who underwent percutaneous nephrolithotripsy/ nephrolithoextraction and contact ureterolithotripsy/ureteroextraction, we also performed a prospective analysis of complications based on the Clavien-Dindo classification in 90 patients who underwent fine fragmentation of stones with various lithotripters: ultrasonic, pneumatic, and holmium laser. The method of controlled stone fragmentation by a diode laser with a hot-spot effect was tested on postoperative samples of 26 renal calculi. For the first time in clinical practice, this method was tested in the bladder cavity (n=10). RESULTS: In the percutaneous nephrolithotripsy group, postoperative infectious and inflammatory complications occurred in 34.1% of cases, in the percutaneous nephrolithoextraction group - in 24.6%, in the contact ureterolithotripsy group - in 7.8%, in the ureterolithoextraction group - in 2.5%. The analysis made it possible to identify factors promoting the development of infectious and inflammatory complications. For the first time in clinical practice, there were successfully performed ten operations of stone fragmentation using a continuous-wave diode laser with a hot-spot effect. Controlled coarse fragmentation of stones providing the possibility to reduce the number of infectious and inflammatory complications was performed in the bladder as a model for testing the method. CONCLUSION: The method of laser-induced controlled coarse fragmentation of stones with a hot-spot effect, developed and tested in clinical practice, is promising for the prevention of infectious and inflammatory complications in patients with potentially infected stones since their fine fragmentation and, consequently, spread of stone-associated toxins and microflora within the urinary system is avoided.