Background: Urine alkalinization can be used for the treatment of some urological diseases.Methods: A series of cases showing the beneficial effects of urine alkalinization with potassium magnesium citrate, theobromine, zinc and vitamin A for the dissolution of uric acid stones and the treatment of other urological pathological conditions is presented.Results: Alkalinization was effective in the dissolution of uric acid renal stones in various clinical conditions. Two cases of bilateral renal stone, four cases of staghorn renal stone, seven patients with unilateral renal stone, and five cases of ureteral stone were described. In this group the age ranged from 46 to 91 years, the M/F ratio was 7/11, the density of the stones ranged between 300 and 528. In most cases the urinary pH ranged from 5 to 5.5. Diabetes was observed in 4 cases, obesity in 4 cases and hyperuricemia in 7. Alkalinizing treatment achieved complete dissolution of the stone in 12 cases and almost complete or partial dissolution in other 6. A combination of potassium magnesium citrate, theobromine, zinc and vitamin A was used in all the cases. In 4 cases the administration of allopurinol was associated. In one case with obstructive ureteral stones, stone dissolution was obtained with the combined administration of bicarbonate via nephrostomy and intravenous bicarbonate and oral treatment with citrates. Stone dissolution of uric acid stones has also been described in some specific clinical conditions such as Crohn's disease with ileostomy, outcome of partial nephrectomy, cross-fused renal ectopia. Alkalinization was also used to prevent encrustation of a self-expanding metallic ureteral stent. Alkalinization has also been employed during the period of Mitomycin administration for the treatment of non-muscle infiltrating bladder tumors and for the treatment of overactive bladder.Conclusions: The findings of these case reports demonstrate that urinary alkalinization with frequent monitoring of urinary pH ​can be successfully employed in the non-surgical treatment of uric acid stones of different sizes in various locations.

Background: Infectious complications are common after percutaneous nephrolithotomy (PCNL). Clinical guidelines recommend, previous to surgery, prolonged antibiotic regimens in patients with preoperative positive urine cultures to reduce infectious risk. However, such strategies may increase selective pressure and promote antimicrobial resistance. Evidence supporting the use of a single antibiotic dose tailored to culture sensitivity in these cases is limited but emerging. Methods: We conducted a retrospective observational study including 187 PCNL procedures performed between 2021 and 2023 under an individualized antibiotic prophylaxis protocol. Patients with negative or contaminated urine cultures received a single empirical dose, while those with recent positive cultures received a single dose based on antimicrobial susceptibility testing. Postoperative complications—including fever, sepsis, and a composite outcome—were analyzed through multivariable logistic regression, comparing high- and low-risk patients. Results: A total of 67.9% of procedures were performed in patients meeting at least one high-risk criterion, including a positive preoperative urine culture in 32.1%. The overall incidence of infectious complications was 11.9% (fever 8.7%, sepsis 3.2%), with no significant differences between risk groups. A low concordance was observed between preoperative and intraoperative urine cultures (Spearman = 0.3954). Conclusions: A single preoperative antibiotic dose adjusted to the antibiogram, even in patients with a positive urine culture, was not associated with increased infectious complications. This approach is an initial step that supports a rational and individualized prophylactic strategy aligned with the goals of antimicrobial stewardship programs (ASPs).