Abstract Introduction: This study aimed to compare the predictive value of preoperative midstream urine culture (PMUC), intraoperative renal pelvic urine culture (RPUC), and stone culture (SC) for postoperative urinary tract infections (UTIs) following percutaneous nephrolithotomy (PCNL). Methods: We retrospectively analyzed 234 patients who underwent supine-PCNL between January 2020 and April 2025. UTI was diagnosed based on systemic inflammatory response syndrome criteria and elevated inflammatory markers. Demographic, peri-, intra- and post-operative data were compared between patients with and without UTI. Multivariate logistic regression identified independent predictors. Results: UTI occurred in 14.1%(n=33) of patients postoperatively, with 72.7% presenting with fever. Culture positivity rates were significantly higher in postoperative UTI-patients (PMUC=27.3%vs.7.5%, SC:39.4%vs.8.0% and RPUC:30.3%vs.6.0%; pConclusions: Intraoperative SC and RPUC are superior to PMUC in predicting UTI after supine PCNL and should be routinely obtained. Female gender and ASA-3 score are independent risk factors. In patients who develop UTI, prior empirical or prophylactic antibiotic use may limit pathogen detection in postoperative urine cultures; therefore, intraoperative cultures play a critical role in early and targeted treatment.
Özgür et al. (Fri,) studied this question.