Asymptomatic Renal Calculi in Recurrent Urinary Tract Infections
Asymptomatic Renal Calculi in Recurrent Urinary Tract Infections
This study will assess patients who have recurrent urinary tract infections and kidney stones
 which are not blocking the kidney or causing other problems. Currently, we don't know if
 taking out these stones will improve recurrent urinary tract infections or not. Patients will
 make a decision with their surgeon about removing or monitoring their stone(s). Whether or
 not their infections continue with surgery or monitoring will be noted, and this information
 may help to inform future treatment decisions. The purpose of this study is to assess if
 treatment of these asymptomatic stones affects the rate of recurrent urinary tract
 infections.
Urinary tract infections (UTIs) are common and have a large burden of disease at the
 population level. This study will assess the effectiveness of removing kidney stones in
 patients who have recurrent UTIs.

 The role of upper urinary tract calculi in UTIs is not well understood. Although there is
 some evidence that some metabolic stones, such as calcium oxalate, can harbor bacteria, it is
 not known if this is clinically significant or if these contribute to clinical infections.

 This study aims to advance the level of evidence in the treatment of non-obstructing
 urolithiasis in the context of recurrent UTIs.

 The aim of this study is to:

 1. Assess the effects of treatment of non-obstructing upper urinary tract calculi on
 recurrent UTIs in the first prospective observational trial in this area

 Patients who meet inclusion criteria will make a decision about treating their asymptomatic
 stones or not with their surgeon as per usual clinical care. The primary outcome will be the
 rate of recurrent urinary tract infections for patients, comparing patients who did and did
 not have their stones treated.

 Patient data is securely stored in de-identified fashion in REDCAP database, following all
 the secure protocols of the institutions involved. The recruitment goal is 80 patients based
 on power calculations to detect the effect size. Statistical analysis will be performed
 between the two groups, with t-test used for normally distributed numerical data and fisher's
 exact or chi-square tests for categorical data.
Inclusion Criteria (all of the following):

 -  recurrent UTIs, defined as 3 positive urine cultures of specific organisms with
 symptoms within 12 months (or 2 positive cultures with symptoms within 6 months) prior
 to clinical assessment

 -  non-obstructing renal stone(s) on imaging within 6 months of initial visit

 Exclusion Criteria:

 -  age < 18 years

 -  pregnancy

 -  hydronephrosis or evidence of obstruction

 -  presence of a foreign body in urinary tract (e.g. Foley, ureteral stent, nephrostomy
 tube) at the time of UTI diagnosis

 -  concurrent bladder calculi

 -  Urinary diversion or previous surgery involving segments of bowel interposed into the
 urinary tract (ileal conduit, ileal ureter etc.)