Breaking the stone and beating the bug: managing ureterolithiasis with Enterococcus faecium in a high-risk patient
Abstract
Ureteral lithiasis in high-risk patients demands a personalized approach due to the interplay of multiple comorbidities and procedural risks. This case report examines a 66-year-old female with recurrent lower ureteral stones resistant to multiple extracorporeal shock wave lithotripsy sessions, complicated by multidrug-resistant Enterococcus faecium infections, chronic coronary syndrome, heart failure with preserved ejection fraction, diabetes mellitus, and a history of ischemic stroke. The failure of conservative treatments required a shift to ureteroscopic laser lithotripsy, preceded by cardiovascular risk optimization and targeted antimicrobial therapy based on advanced microbial diagnostics. Postoperative imaging confirmed complete stone clearance and correct stent placement, ensuring ureteral patency. This case underscores the necessity of multidisciplinary management, integrating precise infection control, cardiovascular stabilization, and minimally invasive techniques to achieve a favorable outcome in a complex patient.
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ureteral lithiasis, E. faecium, extracorporeal shock wave lithotripsy (ESWL), minimally invasive ureteroscopic intervention
2. Karagöz MA, Güven S, Tefik T, et al. Attitudes of urologists on metabolic evaluation for urolithiasis: outcomes of a global survey from 57 countries. Urolithiasis. 2022 Dec;50(6):711-720. doi: 10.1007/s00240-022-01362-x. PMID: 36169664.
3. Kluner C, Hein PA, Gralla O, et al. Does ultra-low-dose CT with a radiation dose equivalent to that of KUB suffice to detect renal and ureteral calculi? J Comput Assist Tomogr. 2006 Jan-Feb;30(1):44-50. doi: 10.1097/01.rct.0000191685.58838.ef. PMID: 16365571.
4. Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, Pace KT, Pais VM Jr, Pearle MS, Preminger GM, Razvi H, Shah O, Matlaga BR. Surgical Management of Stones: American Urological Association/Endourological Society Guideline, PART I. J Urol. 2016 Oct;196(4):1153-60. doi: 10.1016/j.juro.2016.05.090. Epub 2016 May 27. PMID: 27238616.
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