struvite and Bacteriuria

In a prospective, double-blind, placebo-controlled study, the efficacy and safety of acetohydroxamic acid (AHA) in preventing urinary calculogenesis was evaluated in 94 patients with chronic urinary infection. Stone growth occurred in 17% of the AHA group and in 46% of the placebo group (p less than 0.005). Completely reversible side effects consisting predominantly of psychoneurologic and musculo-integumentary symptoms were more prevalent in the AHA group (p less than 0.01). Side effects which were judged 'intolerable' were experienced by 10 (22.2%) of patients in the AHA group and 2 (4.1%) in the placebo group. It is concluded that AHA treatment is effective, relatively safe, and clinically useful in preventing infection-induced urinary calculogenesis.

Topics: Adult; Aged; Bacteriuria; Chronic Disease; Double-Blind Method; Female; Humans; Hydroxamic Acids; Magnesium; Magnesium Compounds; Male; Middle Aged; Palliative Care; Phosphates; Placebos; Prospective Studies; Struvite; Urinary Calculi

To study the association between a stone's struvite content and clinical outcomes and to determine a clinically significant cutoff for defining struvite stones.. This was a retrospective study of all patients who underwent ureteroscopy or PCNL at our institution between 2012 and 2017 and had any component of struvite in the stone analysis. Patients were divided into four groups based on percent struvite content: A (1-25%), B (26-50%), C (51-75%), and D (76-100%). Bacterial characteristics were compared between groups. Univariate and multivariate analyses were performed to evaluate the association between struvite content and postoperative SIRS. Log-rank test was used to compare between the four groups' recurrence rates.. A total of 123 patients were included in the study. Positive preoperative urine culture was found in 31%, 81%, 87%, and 90% of patients from group A, B, C, and D, respectively. E. Coli was the most common pathogen in group A (54%), while Proteus was the most common pathogen in groups C (53%) and D (47%). Enterococci isolation rates remained similar between groups A-D, ranging from 23 to 33%. Postoperative SIRS occurred in 2.4%, 21.3%, 26.7%and 47.4% of the patients from groups A, B, C, and D, respectively, and was associated with struvite content and age on multivariate analysis. Increasing struvite content was associated with higher 2-year recurrence rate.. Higher struvite content is associated with a higher frequency of traditional urea splitting bacteria in urine culture, higher risk for postoperative SIRS, and higher recurrence rate. Struvite content greater than 25% can be used to define a clinically significant struvite stone.

Topics: Aged; Bacteriuria; Enterobacteriaceae; Enterococcus; Escherichia coli; Female; Humans; Kidney Calculi; Klebsiella; Male; Middle Aged; Nephrolithotomy, Percutaneous; Preoperative Period; Proteus; Recurrence; Retrospective Studies; Struvite; Systemic Inflammatory Response Syndrome; Ureteroscopy; Urine

Urinary stasis is a risk factor for recurrent urinary tract infection (UTI). Homozygous mutant Megabladder (Mgb-/-) mice exhibit incomplete bladder emptying as a consequence of congenital detrusor aplasia. We hypothesize that this predisposes Mgb-/- mice to spontaneous and experimental UTI.. Mgb-/-, Mgb+/-, and wild-type female mice underwent serial ultrasound and urine cultures at 4, 6, and 8 weeks to detect spontaneous UTI. Urine bacterial isolates were analyzed by Gram stain and speciated. Bladder stones were analyzed by x-ray diffractometry. Bladders and kidneys were subject to histologic analysis. The pathogenicity of coagulase-negative Staphylococcus (CONS) isolated from Mgb-/- urine was tested by transurethral administration to culture-negative Mgb-/- or wild-type animals. The contribution of urinary stasis to CONS susceptibility was evaluated by cutaneous vesicostomy in Mgb-/- mice.. Mgb-/- mice develop spontaneous bacteriuria (42%) and struvite bladder stones (31%) by 8 weeks, findings absent in Mgb+/- and wild-type controls. CONS was cultured as a solitary isolate from Mgb-/- bladder stones. Bladders and kidneys from mice with struvite stones exhibit mucosal injury, inflammation, and fibrosis. These pathologic features of cystitis and pyelonephritis are replicated by transurethral inoculation of CONS in culture-negative Mgb-/- females, whereas wild-type animals are less susceptible to CONS colonization and organ injury. Cutaneous vesicostomy prior to CONS inoculation significantly reduces the quantity of CONS recovered from Mgb-/- urine, bladders, and kidneys.. CONS is an opportunistic uropathogen in the setting of urinary stasis, leading to enhanced UTI incidence and severity in Mgb-/- mice.

Topics: Animals; Bacteriuria; Cystitis; Disease Susceptibility; Female; Hydrogen-Ion Concentration; Magnesium Compounds; Mice; Mice, Mutant Strains; Phosphates; Pyelonephritis; Staphylococcus; Struvite; Urinary Bladder; Urinary Diversion; Urinary Tract; Urinary Tract Infections; Urolithiasis

To examine the role of clean intermittent catheterization (CIC) as a possible predisposing risk factor for bladder calculi, assessing risk factors in patients with and without bladder augmentation, and to evaluate management options for bladder calculi in these patients.. The records of 403 patients who were using a regimen of CIC between January 1981 and March 1998 were reviewed to identify those forming bladder calculi; stones were diagnosed in 28 patients. The patients were categorized as: group 1, patients with no bladder augmentation who catheterized urethrally (227, group 1a) or via a Mitrofanoff conduit (18, group 1b); group 2, patients with augmented bladders who catheterized urethrally (100, group 2a) or via a Mitrofanoff conduit (58, group 2b). The incidence of bladder calculi in each group was determined and compared statistically where applicable. The success of the treatment options for stone management was reviewed.. Bladder calculi developed in 5% of patients in group 1a, 8% in group 2a, 11% in group 1b, and 10% in group 2b; the incidence of calculi was not significantly different among the groups. Of these patients, 18 (64%) were asymptomatic at the time of diagnosis and significant bacteriuria was found in 23 (88%). Difficulty in catheterizing either the Mitrofanoff conduit or the native urethra was reported in 14 (50%) of these patients. Calculi were more often solitary (71%) and typically composed of struvite or apatite. Calculi were managed by open cystolithotomy in 15 patients (54%) and endoscopically in 13 (46%). Stones recurred in nine patients (32%) after treatment, comprising four of six patients treated endoscopically with electrohydraulic lithotripsy and in five of 15 after open cystolithotomy. The mean interval to recurrence was 22.8 months.. These results suggest that patients on a regimen of CIC are at risk of developing bladder calculi but the incidence of calculi is not influenced by bladder augmentation. The presence of a Mitrofanoff conduit was associated with a slightly increased incidence of calculus formation. Open cystolithotomy was associated with a lower stone recurrence rate but there were too few patients to draw definitive conclusions.

Topics: Adolescent; Adult; Apatites; Bacteriuria; Child; Child, Preschool; Female; Humans; Lithotripsy; Magnesium Compounds; Male; Phosphates; Prognosis; Risk Factors; Struvite; Urinary Bladder Calculi; Urinary Catheterization; Urinary Diversion

The stones removed from 273 patients (220 males, 53 females) with bladder stones and 27 patients with urethral stones (males) were analyzed by infrared spectroscopy. Of these stones 50.0% contained magnesium ammonium phosphate (MAP), 39.9% calcium (oxalate and/or phosphate), 9.4% uric acid (urate), and 0.7% cystine. The disorders associated with bladder stones were prostatic hyperplasia and cancer (47.8%), neurogenic bladder (11.8%), urethral stricture (3.6%) and so on in males, and neurogenic bladder (48.1%), after operation of uterus (29.0%), bladder cancer (5.7%) and so on in females. Urinary infections were complications in 59.3% of patients with MAP stones, 41.2% with urate stones and 20.0% with calcium stones. The most often isolated bacteria from the infected urine were of the Proteus species.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacteriuria; Calcium Oxalate; Calcium Phosphates; Chi-Square Distribution; Child; Child, Preschool; Cystine; Female; Humans; Magnesium Compounds; Male; Middle Aged; Phosphates; Prostatic Hyperplasia; Spectrophotometry, Infrared; Struvite; Urethral Diseases; Uric Acid; Urinary Bladder Calculi; Urinary Bladder, Neurogenic; Urinary Calculi; Urinary Tract Infections; Urologic Diseases

To clarify the significance of retained stone particles after extracorporeal shock wave lithotripsy (ESWL) for struvite renal calculi we followed 22 otherwise healthy women for 16 to 52 months (mean 39 months). Each patient had persistent Proteus mirabilis bacteriuria before ESWL and received a standardized regimen of antimicrobial therapy in the perioperative period only. Of the 22 patients 19 (86%) were cured of the persistent bacteriuria. Of these 19 patients 16 had retained stone particles at the beginning of surveillance and 10 had retained particles at last followup. None of the particles produced symptoms or enlarged. However, 1 of the patients who was rendered stone-free had a P. mirabilis reinfection at 20 months and a new stone developed. Of the 22 patients 3 (14%) had continued persistent P. mirabilis bacteriuria after ESWL. Two patients were subsequently cured of the infection with antibiotics alone (1), and with antibiotics and extraction of a new ureteral stone (1). The remaining patient had expansion of retained stone particles after 51 months of surveillance. We conclude that a stone-free kidney is an unrealistic objective of ESWL monotherapy for struvite renal calculi. However, the treatment usually will eradicate the accompanying persistent bacteriuria and sterile stone particles will not enlarge during the first 2 to 4 years after treatment.

Topics: Adult; Aged; Bacteriuria; Female; Follow-Up Studies; Humans; Kidney Calculi; Lithotripsy; Magnesium; Magnesium Compounds; Male; Middle Aged; Phosphates; Prospective Studies; Struvite

One hundred fifty specimens of urinary calculi from 150 cats were analyzed by at least 1 of 4 quantitative methods. Struvite (magnesium ammonium phosphate) was the predominant mineral substance encountered, with 104 (69%) of the calculi being composed entirely of struvite and 23 (15%) being composed partially of struvite. Most (93%) of the calculi were located in the urinary bladder. Growth of bacteria was observed in samples from calculi or urine from 30 (41%) of 74 cats. Coagulase-positive staphylococci were isolated from the urine or calculi from 17 cats (45% of bacteria isolated). Ten other bacterial species were isolated. Median and mean ages of the cats were 5.0 and 5.1 years, respectively. Domestic short-hair and domestic longhair breeds predominated. Fifty-seven percent of the calculi came from females, 43% from males. The distribution by gender did not differ significantly (P greater than 0.2) among the 3 groups (domestic shorthair, domestic longhair, and other). However, the distribution of struvite calculi differed significantly (chi 2 = 15.5, P less than 0.001) by age and gender; among cats less than or equal to 2 years of age, males predominated 2:1 over females, and among cats greater than 2 years of age, females predominated by nearly 3:1 over males. When compared with the general population, females greater than 2 years old were significantly (chi 2 = 15.4, P less than 0.001) overrepresented.

Topics: Age Factors; Animals; Apatites; Bacteria; Bacteriuria; Breeding; Calcium Oxalate; Cat Diseases; Cats; Female; Magnesium; Magnesium Compounds; Male; Phosphates; Sex Factors; Struvite; Uric Acid; Urinary Calculi

Topics: Bacteriological Techniques; Bacteriuria; Computers; Drug Interactions; Humans; Hydroxamic Acids; Magnesium; Magnesium Compounds; Netilmicin; Phosphates; Proteus Infections; Proteus mirabilis; Struvite; Urease; Urinary Calculi

Thirty-three patients operated on for renal staghorn calculous disease were studied retrospectively with respect to urine and stone composition, bacteriuria, and abnormalities of the urinary tract. Calcium phosphate was the most common stone constituent, present in 30 of 31 concrements. Twenty-one of these stones also contained magnesium ammonium phosphate, despite the fact that only 10 patients had presented evidence of urinary tract infection during the initial period of the disease. Twenty-four-hour urine composition was normal in only 3 patients. In 59 per cent an increased CaOx risk index was observed suggesting that CaOx risk factors might contribute to the development of staghorn concrements. A metabolic evaluation of staghorn stone formers appears to be of importance for design of the postoperative treatment.

Topics: Adolescent; Adult; Bacteriuria; Calcium Oxalate; Calcium Phosphates; Female; Humans; Kidney Calculi; Magnesium; Magnesium Compounds; Male; Middle Aged; Phosphates; Risk; Struvite; Urologic Diseases

Topics: Adult; Ampicillin; Bacteriuria; Drug Combinations; Female; Humans; Magnesium; Magnesium Compounds; Phosphates; Pregnancy; Pregnancy Complications, Infectious; Recurrence; Staphylococcal Infections; Staphylococcus; Struvite; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Ureteral Calculi

The pre-operative urine, pelvic urine, removed calculi and calculus washings were examined bacteriologically in 24 patients undergoing removal of intrarenal calculi. Four of seven patients with struvite calculi had an infected pre-operative midstream urine specimen and six of the seven removed calculi demonstrated significant bacterial growth. Proteus mirabilis was the commonest organism isolated. Of 17 patients with oxalate calculi only one had an infected pre-operative urine culture, but in four cases the removed stones were infected. Quantitative bacteriological culture of the stones and their washings demonstrated that infection is within the stone itself. Pre-operative urine culture failed to predict infection within the stone in 60% of patients with infected stones. The results suggest that the presence of infected urine together with the presence of renal calculus is indication for removal of the calculus.

Topics: Adult; Aged; Bacteriuria; Enterobacteriaceae Infections; Enterococcus faecalis; Escherichia coli; Female; Humans; Kidney Calculi; Klebsiella pneumoniae; Magnesium; Magnesium Compounds; Male; Middle Aged; Oxalates; Oxalic Acid; Phosphates; Proteus; Pseudomonas aeruginosa; Pseudomonas Infections; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Struvite

The bacteriological status of the pre-operative urine, removed calcium and the pelvic urine was studied in 63 consecutive patients undergoing removal of intrarenal calculi. The overall infection rates in the pre-operative urine, removed calculi and pelvic urine were 29%, 38% and 30% respectively. In patients with staghorn calculi, 58% of patients had an infected pre-operative M.S.S.U., and 82.5% of removed calculi demonstrated significant bacterial growth, with Proteus mirabilis being the predominant organism isolated. In patients with single or multiple oxalate calculi, 17% had an infected pre-operative M.S.S.U., and 22% of removed calculi demonstrated a significant bacterial growth. The findings would indicate that the presence of a positive M.S.S.U. in a patient with a renal calculus is an indication for surgical removal.

Topics: Adult; Aged; Bacteriuria; Female; Humans; Kidney Calculi; Magnesium; Magnesium Compounds; Male; Middle Aged; Oxalates; Phosphates; Proteus mirabilis; Struvite

We determined the bacteriology of apparently infected renal calculi and accompanying urinary tract infections, and assessed the potential clinical value of the culture results. Twenty-two branched renal calculi from 16 patients were cultured. Fifteen calculi were infected with 1 or more urease-producing gram-negative enteric bacterium, 2 were infected with a urease-producing bacterium and a nonurease-producing organism, and 5 were sterile. Immersion of infected stones in antimicrobial solutions before culture reduced or eliminated surface bacteria but usually did not eradicate bacteria within the stone. The bacteriology of a stone or stones could be predicted on the basis of available urine culture results in only 2 of the 16 cases. These data suggest that branched renal calculi associated with bacteriuria usually are infected but that documentation of infection and identification of the infecting organism require culture of the stone.

Topics: Anti-Bacterial Agents; Apatites; Bacteriuria; Female; Humans; Kidney Calculi; Magnesium; Magnesium Compounds; Male; Methods; Phosphates; Proteus mirabilis; Pseudomonas aeruginosa; Struvite; Urease; Urinary Tract Infections

The calculolytic effect of a diet designed to reduce the urine concentration of urea, P, and Mg was evaluated in female Beagles with induced urease-positive urinary tract infections and struvite urolithiasis and in female Beagles with induced sterile struvite urolithiasis. The reduced-protein calculolytic diet induced urolith dissolution in 5 of 6 infected dogs with struvite urolithiasis in 2 to 5 months (means = 14.4 weeks). At the end of 6 months, uroliths in comparable control dogs fed a maintenance diet were 5 times larger and 14 times heavier than at the beginning of the study. The calculolytic diet induced urolith dissolution in 6 of 6 noninfected dogs with struvite uroliths in 2 to 4 weeks (means = 3.3 weeks). Four uroliths in noninfected dogs fed the maintenance diet dissolved over a period of 2 to 5 months (means = 14 weeks). Urolith dissolution in dogs fed the calculolytic diet was associated with diet-induced diuresis, reduction in urine pH, reduction in urine concentration of urea ammonia, P, and Mg, and increase in urine titratable acidity. Consumption of the calculolytic diet was also associated with significant (P = less than 0.01) reduction in the serum concentration of urea and albumin and a significant (P = less than 0.01) increase in serum hepatic alkaline phosphatase activity. Concomitant occurrence of hydropic degeneration of hepatocytes indicated that these biochemical and morphologic changes were associated with dietary protein restriction.

Topics: Animals; Bacteriuria; Diet; Dog Diseases; Dogs; Female; Liver; Magnesium; Magnesium Compounds; Phosphates; Staphylococcus aureus; Struvite; Urease; Urinary Bladder; Urinary Bladder Calculi

Prevention of the formation of struvite and carbonate-apatite calculi, which rapidly increase in size and tend to recur, is of prime importance. One of the urease inhibitors, hydroxycarbamide, was studied in vitro. The results are favourable and justify further studies aimed at the local application of the inhibitor.

Topics: Ammonia; Apatites; Bacteriuria; Carbonates; Dose-Response Relationship, Drug; Humans; Hydrogen-Ion Concentration; Hydroxyurea; Kidney Calculi; Magnesium; Magnesium Compounds; Phosphates; Proteus Infections; Struvite; Urease

Effective treatment and prevention of urolithiasis depends on accurate determination of the chemical nature of the uroliths. A widely used qualitative chemical procedure was compared with quantitative crystallographic analysis of 272 canine uroliths. Agreement between the 2 methods was 78%. Qualitative analysis failed to detect 62% of calcium-containing uroliths and 83% of carbonate apatite uroliths. Qualitative analysis gave false-positive results for urates in 55% of cystine uroliths. Mixed uroliths comprising 6% of the total could not be classified without quantitative analysis. Silicate, cystine, and urate uroliths generally were of pure composition. Crystallographic analysis indicated the following distribution of major types: struvite, 69%; calcium oxalate, 10%; urate, 7%; silicate, 3.5%; cystine, 3.2%; calcium phosphate, 1%; and mixed, 6%. Among dogs with struvite uroliths, 66% had positive results of bacterial culturing from the urinary bladder. Six breeds (Miniature Schnauzer, Welsh Corgi, Lhasa Apso, Yorkshire Terrier, Pekingese, and Pug) had a significantly higher risk for urolithiasis, compared with other breeds. The German Shepherd Dog had a significantly lowered risk, compared with other breeds. Two breeds had significant relationship to a specific type of urolith: Miniature Schnauzer for oxalate, and Dalmatian for urate (P less than 0.001). It was concluded that quantitative analysis, using crystallography, was superior for the detection of calcium oxalate, carbonate apatite, cystine, urate, and mixed uroliths.

Topics: Animals; Bacteriuria; Calcium Oxalate; Calcium Phosphates; Crystallography; Cystine; Dog Diseases; Dogs; Female; Magnesium; Magnesium Compounds; Male; Phosphates; Silicic Acid; Struvite; Uric Acid; Urinary Calculi; Urinary Tract Infections