Evaluation of the effectiveness of dioxydin metaphylaxis of nephrolithiasis in percutaneous nephrolithotripsy
Keywords:
percutaneous nephrolithotomy, dioxidine, metaphylaxis, stone recurrence, nephrolithiasisAbstract
Background and aim. Infectious complications and stone recurrence remain major challenges after percutaneous nephrolithotomy (PCNL) for large kidney stones. This study aimed to evaluate the effectiveness of adjunctive intracavitary 1% dioxidine administration for metaphylaxis of for reducing postoperative infectious complications and stone recurrence following PCNL.
Methods. This prospective, randomized, single-blind controlled trial included 95 patients (aged 18–70 years) with kidney stones >2 cm undergoing PCNL. Patients were randomized 1:1 into control (standard systemic ceftriaxone therapy, n=48) and intervention groups (standard therapy plus intracavitary 10 ml 1% dioxidine intraoperatively and on postoperative days 1–2, n=47). Primary outcomes were bacteriuria and leukocyturia at 7 days and 3 months. Secondary outcomes included Clavien–Dindo complications, stone recurrence at 6 months (low-dose CT), laboratory parameters, and stone composition.
Results. Intracavitary dioxidine significantly reduced bacteriuria at 7 days (10.6% vs 45.8%, p<0.001) and 3 months (4.3% vs 52.1%, p<0.001). Leukocyturia was markedly lower in the dioxidine group at both time points (p<0.001). Clinically significant complications (Clavien–Dindo ≥II) occurred in 4.3% vs 25.0% (p=0.004), and stone recurrence at 6 months was 4.3% vs 22.9% (p=0.008). Difference-in-Differences analysis confirmed a strong independent effect of dioxidine on urine leukocytes at 1 week (–9.24 ± 2.42, p<0.001) and 3 months (–6.52 ± 2.29, p=0.005). No adverse reactions were observed, and renal function remained stable.
Conclusions. Adjunctive intracavitary 1% dioxidine during and after PCNL is a safe and effective strategy for reducing postoperative infectious complications and stone recurrence. Larger multicenter trials are warranted.
References
1. Türk C, Petřík A, Sarica K, et al. EAU Guidelines on Diagnosis and Conservative Management of Urolithiasis. Eur Urol. 2016 Mar;69(3):468-74. doi: 10.1016/j.eururo.2015.07.040
2. Scales CD Jr, Smith AC, Hanley JM, et al. Prevalence of kidney stones in the United States. Eur Urol. 2012;62(1):160-5. doi: 10.1016/j.eururo.2012.03.052
3. Espinosa-Ortiz EJ, Eisner BH, Lange D, Gerlach R. Current insights into the mechanisms and management of infection stones. Nat Rev Urol. 2019 Jan;16(1):35-53. doi:10.1038/s41585-018-0120-z
4. Michel MS, Trojan L, Rassweiler JJ. Complications in percutaneous nephrolithotomy. Eur Urol. 2007;51(4):899-906. doi: 10.1016/j.eururo.2006.10.020
5. Rashid AO, Fakhralddin SS. Risk factors for fever and sepsis after percutaneous nephrolithotomy, Asian J Urol. 2016;3(2):82-87. doi: 10.1016/j.ajur.2016.03.001
6. Wang S, Yuan P, Peng E, et al. Risk Factors for Urosepsis after Minimally Invasive Percutaneous Nephrolithotomy in Patients with Preoperative Urinary Tract Infection. Biomed Res Int. 2020 Jan 2;2020:1354672. doi: 10.1155/2020/1354672
7. Piopov DA, Anuchina NM, Terent'ev AA, et al. Dioxidin: antimicrobial activity and prospects of its clinical use at present. Antibiot Khimioter. 2013;58(3-4):37-42. Russian. PMID: 24640151
8. Bol'shakov LV. Antibacterial activity of dioxidine under aero- and anaerobic conditions. Antibiot Med Biotekhnol. 1986 Oct;31(10):760-4. Russian. PMID: 3789685
9. Bekbergenov BM, Antipov AV, Danil'iants EV, et al. Clinical and experimental study of dioxidine. Its antibacterial action. Antibiotiki. 1982 May;27(5):349-52. Russian. PMID: 6179463
10. Imzharov TA, Zhakiev BS, Sarkulov MN, et al. The effectiveness of metaphylaxis of nephrolithiasis during percutaneous nephrolithotripsy: a systematic review and meta-analysis. Georgian Med News. 2025;(7-8):314-322. PMID: 41072532
11. Lai WS, Assimos D. The Role of Antibiotic Prophylaxis in Percutaneous Nephrolithotomy. Rev Urol. 2016;18(1):10-4. PMID: 27162507
12. Hrynyshyn A, Simões M, Borges A. Biofilms in Surgical Site Infections: Recent Advances and Novel Prevention and Eradication Strategies. Antibiotics (Basel). 2022;11(1):69. doi: 10.3390/antibiotics11010069
13. Kranz J, Bartoletti R, Bruyère F, et al. European Association of Urology Guidelines on Urological Infections: Summary of the 2024 Guidelines. Eur Urol. 2024;86(1):27-41. doi: 10.1016/j.eururo.2024.03.035
14. González-Díaz A, Gil-Moradillo J, Rosillo-Ramírez N, et al. Analysis of patient outcomes after urological surgery during the second and third waves of SARS-CoV-2 pandemic in a high incidence area. J Healthc Qual Res. 2022;37(6):382-9. doi: 10.1016/j.jhqr.2022.03.004
15. Zisman AL. Effectiveness of Treatment Modalities on Kidney Stone Recurrence. Clin J Am Soc Nephrol. 2017;12(10):1699-708. doi: 10.2215/CJN.11201016
16. Tang C, Liu C, Jiang W, et al. The high-risk factors of urinary infectious stones: a retrospective study. Transl Androl Urol. 2025;14(8). doi: 10.21037/tau-2025-244
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Talgat A. Imzharov, Melih Balci, Bazylbek S. Zhakiev, Oleg M. Kurmangaliyev, Marat N. Sarkulov, Yilmaz Aslan, Valentin N. Pavlov, Irina A. Lakman, Mirsaid S. Kelimberdiev
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.
How to Cite
