Editorial Comment on: Prediction of Bacteriuria Based on Clinical or Laboratory Parameters in Patients with Indwelling Ureteral Stents Before Ureterorenoscopy Should Not Substitute for Urine Cultures by Weber et al.

Weber and colleagues ¹ present a retrospective single-institution study of 462 patients who had indwelling ureteral stents and who underwent ureterorenoscopy for urolithiasis. Of these patients, 101 (22%) had bacteriuria based on a positive preoperative urine culture. On multivariable analysis, older age, female gender, elevated serum C-reactive protein levels, nitrite positivity, pyuria, and high urine pH were significantly associated with increased odds of bacteriuria. Nevertheless, given the risk of postoperative urosepsis, these authors conclude that the use of predictive models based on clinical and laboratory parameters should not substitute for obtaining a preoperative urine culture.

The authors here make a commendable effort to create bacteriuria risk classification groups to address the issue of delays and/or cancellations of surgeries because of pending urine culture results. Their findings on the predictive inadequacy of clinical and laboratory parameters are in agreement with a previously published study by Pooli and colleagues (reference 6 in article), ² who looked at the correlation between urinalysis findings and urine culture results in 84 patients with indwelling ureteral stents.

However, as Weber and colleagues themselves have already acknowledged, a limitation of their work here is the lack of data on the presence/absence of patient symptoms, which are a crucial component of the clinical impression.