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Pathogenic bacteria are found in almost 40% of stones, where they form biofilms that are protected from systemic antibiotic treatments. Stone surgeries disperse biofilms resulting in up to 30% of patients developing postoperative urinary tract infections and 15% developing sepsis. This work is based on the hypothesis that chitosan, an antimicrobial polymer, can eradicate bacterial biofilms present in the stone and potentially serve as an adjunct to irrigation during stone surgery. First, fresh patient\u2010derived kidney stone fragments (<jats:italic>n<\/jats:italic>\u00a0=\u00a056) are collected from stone surgeries. A total of 32% of stones are colonized, predominantly with <jats:italic>Enterococcus faecalis<\/jats:italic>, <jats:italic>Escherichia coli<\/jats:italic>, and <jats:italic>Proteus mirabilis<\/jats:italic>. A short, clinically relevant, chitosan treatment reduces the bacterial burden on colonized stones by over 90% in all specimens tested, regardless of stone composition and bacterial strain. To assess this approach toxicity, ex vivo human ureters and in vivo porcine bladders are exposed to topical chitosan irrigation. No toxic or pathological abnormalities other than urothelial exfoliation are noted. In conclusion, chitosan effectively disrupts kidney stone\u2010associated bacterial biofilms with minimal urothelial toxicity and may provide an effective and safe approach to reducing postoperative complications.<\/jats:p>","DOI":"10.1002\/adhm.202403470","type":"journal-article","created":{"date-parts":[[2025,3,1]],"date-time":"2025-03-01T19:03:42Z","timestamp":1740855822000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Disrupting Biofilms on Human Kidney Stones\u2013A Path Toward Reducing Infectious Complications During Stone Surgery"],"prefix":"10.1002","volume":"14","author":[{"given":"Daniel","family":"Massana Roquero","sequence":"first","affiliation":[{"name":"Department of Urology Stanford University School of Medicine  Stanford CA 94305 USA"},{"name":"Veterans Affairs Palo Alto Health Care System  Palo Alto CA 94304 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace H.","family":"Holton","sequence":"additional","affiliation":[{"name":"Veterans Affairs Palo Alto Health Care System  Palo Alto CA 94304 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. 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