Heterogeneity in stone culture protocols and endourologist practice patterns: a multi-institutional survey

David T. Tzou, Karen L. Stern, Brian D. Duty, Ryan S. Hsi, Noah E. Canvasser, Smita De, Ava C. Wong, Charis R. Royal, Meleighe L. Sloss, Justin B. Ziemba, Jonathan D. Harper, Seth K. Bechis, Anna M. Zampini, Michael S. Borofsky, John Roger Bell, Justin I. Friedlander, David A. Leavitt, Amihay Nevo, Nishant D. Patel, Roshan M. PatelZeph Okeke, Marcelino E. Rivera, Chiu Hsieh Hsu, Thomas Chi, Gayatri Vedantam, William D. Lainhart

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Kidney stone cultures can be beneficial in identifying bacteria not detected in urine, yet how stone cultures are performed among endourologists, under what conditions, and by what laboratory methods remain largely unknown. Stone cultures are not addressed by current clinical guidelines. A comprehensive REDCap electronic survey sought responses from directed (n = 20) and listserv elicited (n = 108) endourologists specializing in kidney stone disease. Questions included which clinical scenarios prompt a stone culture order, how results influence post-operative antibiotics, and what microbiology lab protocols exist at each institution with respect to processing and resulting stone cultures. Logistic regression statistical analysis determined what factors were associated with performing stone cultures. Of 128 unique responses, 11% identified as female and the mean years of practicing was 16 (range 1–46). A specific ‘stone culture’ order was available to only 50% (64/128) of those surveyed, while 32% (41/128) reported culturing stone by placing a urine culture order. The duration of antibiotics given for a positive stone culture varied, with 4–7 days (46%) and 8–14 days (21%) the most reported. More years in practice was associated with fewer stone cultures ordered, while higher annual volume of percutaneous nephrolithotomy was associated with ordering more stone cultures (p < 0.01). Endourologists have differing practice patterns with respect to ordering stone cultures and utilizing the results to guide post-operative antibiotics. With inconsistent microbiology lab stone culture protocols across multiple institutions, more uniform processing is needed for future studies to assess the clinical benefit of stone cultures and direct future guidelines.

Original languageEnglish (US)
Article number15
Issue number1
StatePublished - Dec 2023


  • Antibiotics
  • Infection
  • Kidney stones
  • Sepsis
  • Stone culture

ASJC Scopus subject areas

  • Urology


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