Infection et lithiase urinaire

Visceral Adiposity and Its Impact on Nephrolithiasis: A Narrative Review

Kidney stones represent a serious medical problem, resulting from several factors such as diet, genetics, and certain medical conditions. Visceral adipose tissue has been shown in recent research to play a significant role in kidney stone formation, making it a more precise indicator than traditional obesity indicators such as body mass index. The main aim of this review is to summarize studies on visceral obesity as a predictive marker for nephrolithiasis and to highlight new mechanistic pathways such as adipokine-mediated inflammation and its impact on kidney stone formation. This review emphasizes the importance of considering visceral fat in the prevention and management of kidney stones, suggesting that targeted strategies to reduce visceral fat could decrease the incidence of kidney stones and their management costs. Further prospective studies are needed to validate these findings and propose preventive strategies based on visceral adiposity assessments.

Use of Antibiotic Prophylaxis for Polymicrobial Urine Culture before Urological Surgery: A Pilot Study

INTRODUCTION

Preoperative polymicrobial urine cultures are common, but the associated risk of nosocomial infection is currently unknown. We aimed to analyze the risk of postoperative infection in patients with preoperative polymicrobial urine cultures.

METHODS

This was a prospective cohort study conducted from November 2018 to October 2020. Polymicrobial urine cultures were defined by at least the presence of 3 bacteria without leukocyturia threshold on two consecutive samples in the month preceding the surgical procedure. Data on postoperative infections were collected during hospitalization until day 30. A postoperative infection was defined by the occurrence of clinical signs (fever, chills, and suppurated process on the surgical site) associated with the prescription of an antibiotic therapy.

RESULTS

Sixty-eight patients were included, and seven developed a postoperative infection with a microbe identified in blood or urine cultures. There was a significant association between leukocyturia ≥104 (p = 0.02) and the administration of intraoperative antibiotic prophylaxis (p < 0.001). In contrast, there was no significant association between postoperative infections for patients with polymicrobial preoperative urine cultures and having received or not an empirical antibiotic therapy.

CONCLUSION

The rate of postoperative infection in patients with polymicrobial urine culture before urological procedure was 10.2%. Further studies are needed to assess the antibiotic prophylaxis to be used in this situation.

The Synergistic Effect of Three Essential Oils against Bacteria Responsible for the Development of Lithiasis Infection: An Optimization by the Mixture Design

The present study aimed to determine the chemical composition and the synergistic effect of three plants' essential oils (EOs), Eucalyptus camaldulensis (ECEO), Mentha pulegium (MPEO), and Rosmarinus officinalis (ROEO), against three bacterial strains, Proteus mirabilis, Klebsiella pneumoniae, and Staphylococcus aureus, in order to increase the antimicrobial effectiveness by the use of a low dose of essential oils, consequently decreasing the toxicity and negative impact. For this reason, an augmented simplex-centroid mixture design was used to build polynomial models in order to highlight the synergy between the essential oils against bacterial strains. Antimicrobial effect screening was performed by the disc diffusion method and the minimal inhibitory concentrations (MIC) were also studied. The gas chromatography/mass spectrometry (GC-MS) results show the richness of these essential oils by terpenic compounds, especially 1,8-Cineole and P-Cymene for ECEO, Pulegone for MPEO, and α-Pinene and Camphene for ROEO. Moreover, a significant antibacterial effect has been demonstrated and the best values were revealed by MPEO and ECEO against P. mirabilis and K. pneumoniae, with inhibition zones (IZ) of 25 and 20 mm, respectively, and an MIC of 0.0391% (v:v) against K. pneumoniae. The optimal mixtures showed a synergistic effect of essential oils, and the lowest minimal inhibitory concentrations of the mixtures (MICm) were in the order of 29.38% of MPEO, 45.37% of ECEO, and 25.25% of ROEO against P. mirabilis and in the order of 60.61% of MPEO and 39.39% of ROEO against K. pneumoniae. These results indicate the antibacterial efficacy of the three essential oils combined and suggest their importance in the treatment of urinary tract infections caused by resistant bacterial strains.

[Chemical composition of urinary stones and associated factors in the Democratic Republic of Congo]

To compare the chemical composition of the upper and lower urinary tract stones in Congolese patients, and to identify factors associated with the different types of stones. Stones from 119 patients originating from the upper tract and 75 from the lower tract were analyzed by infrared spectrophotometry. Among 119 patients with upper tract stones, age ranged from 10 to 81 years with a mean (SD) of 45.8 (13.6) years; males were the majority (55.5%). The main types of stones identified were whewellite (79%). For the 75 patients with lower apparatus stones, age ranged from 4 to 87 years with a mean (SD) of 51.6 (21.6) years; the majority were males (89.3%). The main types of stones were whewellite (44%) and anhydrous uric acid (22.7%). Overall, the factors associated with calcium oxalate included: site [4.95 (95% CI 2.35-10.44)] and diameter [3.03 (95% CI 1.45-6.25)]; patient's place of residence [0.05 (95% CI 0.01-0.29)] was associated with calcium phosphate. Infection stones were associated with; site [0.19 (95% CI 0.06-0.63)] and diameter [0.10 (95% CI 0.03-0.38)]. Finally, age 0.26 (95% CI 0.09-0.71) and stone site [0.23 (95% CI 0.07-0.68)] were associated with uric stones. The epidemiological and chemical profile of upper and lower tract stones were different. Several factors were associated with the chemical and crystalline composition of stones in the Democratic Republic of Congo.

[Multiple sclerosis and intermittent self-catheterization]

INTRODUCTION

Lower urinary tract dysfunctions are frequent in patients with multiple sclerosis (MS). These disorders impair quality of life and can cause urological complications. In cases of urinary retention or incomplete bladder emptying, clean intermittent self-catheterization is the preferred option where possible.

OBJECTIVE

To identify data concerning the use of intermittent self-catheterization by patients with MS.

BIBLIOGRAPHIC SOURCE

A review was done using Medline/Pubmed with selection of articles in either English or French. The key words were: « multiple sclerosis and intermittent catheterization, self-catheterization, neuro-urology/urinary guidelines, continent stoma, continent vesicostomy».

STUDY SELECTION

Studies were selected if they concerned either multiple sclerosis exclusively or with a majority of cases concerning MS.

RESULTS

Intermittent self-catheterization is recommended and commonly used in patients with MS. Studies are rare in this specific population. Questions still remain about indications and practicalities in this disease. Indications must be individually evaluated according to symptoms and complications. The use of self-catheterization can improve symptomatology or quality of life, however, global urinary management is necessary. Urinary infection is the most frequently reported side effect. The teaching of self-catheterization should take into account physical and cognitive impairment. Due to the developing nature of the pathology, indications and the patients' ability to carry out self-catheterization should be regularly assessed.

LIMITATIONS

The search was limited to a single bibliographic source and studies are rare.

CONCLUSION

Further studies are necessary to increase knowledge of self-catheterization specificities in MS patients compared to other neurogenic patients.

Crosstalk among dietary polyunsaturated fatty acids, urolithiasis, chronic inflammation, and urinary tract tumor risk

Based on a consistent bulk of experimental and epidemiologic works, we proposed that abnormal metabolism and/or dietary deprivation of essential polyunsaturated fatty acids by inducing a chronic and subclinical essential fatty acid deficiency (EFAD) in urothelial cell membranes may enhance the risk for urinary tract tumor (UTT) development. This threat may be enhanced by the unusual fact that the fatty-acid profile of the normal urothelium is similar to that reported in EFAD. The risk for UTT may be worsened when coexisting with a low-grade chronic inflammation (LGCI) state induced by urolithiasis or disbalance management of peroxides, free radical molecules, and their quenchers. There is cumulative evidence linking the LGCI of the urinary tract mucosa, calculi, and UTT, due to the long-standing release of promitotic, promutagen, and pro-inflammatory antiapoptotic cytokines in these conditions. The dual role played by pro- and anti-inflammatory eicosanoids and bioactive lipids, cytokines, and the disbalance of lipid peroxidation is discussed, concluding that the moderate, long-standing consumption or dietary supplementation of ω-3 PUFAs may improve the chances of avoiding UTT development.