Looking beyond the guidelines for perioperative antibiotics in nephrolithiasis

Establishing guidelines for the use of perioperatively antibiotics for patients being treated for urinary stone disease presents a particularly challenging clinical issue. Nephrolithiasis patients represent a variety of etiologies, from obstructive to infectious stones, and their treatment ranges from practically non-invasive in the form of extracorporeal shockwave therapy to relatively invasive with percutaneous approaches. In addition, within each procedure type, there is a large gradation in level of associated morbidity—a ureteroscopy with a basket stone extraction for a distal 5 mm stone likely represents a much different infectious risk compared to a ureteroscopy with laser lithotripsy for a proximal 1 cm ureteral stone requiring ureteral orifice dilation along with access sheath placement.