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Emergent ureteric stent vs percutaneous nephrostomy for obstructive urolithiasis with sepsis: patterns of use and outcomes from a 15‐year experience
Author(s) -
Goldsmith Zachariah G.,
OredeinMcCoy Olugbemisola,
Gerber Leah,
Bañez Lionel L.,
Sopko David R.,
Miller Michael J.,
Preminger Glenn M.,
Lipkin Michael E.
Publication year - 2013
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12161
Subject(s) - medicine , odds ratio , percutaneous nephrostomy , intensive care unit , stent , sepsis , percutaneous , confidence interval , comorbidity , surgery
Objectives To characterize the use of emergent JJ ureteric stent placement and percutaneous nephrostomy ( PCN ) for patients with obstructive urolithiasis with sepsis, and to determine whether outcomes differ between the two treatment methods.Patients and Methods A total of 130 patients with obstructive urolithiasis and systemic inflammatory response syndrome criteria were identified retrospectively from a single health system database from 1995 to 2011. Primary outcomes included stone‐related and clinical variables which predicted the use of each treatment method. Secondary outcomes included the length of hospital stay, risk of intensive care unit ( ICU ) admission, and surgical approach used for definitive stone management.Results The overall rate of failed procedures was 2.3% (3/130), with one in‐hospital death (0.8%). Patients treated with PCN had larger stones (10 vs 7 mm, P = 0.031), and were more acutely ill (acute physiology, age, chronic health evaluation [ APACHE ] II scores of 15 vs 11, P = 0.036) than those treated with JJ stent placement. Patients treated with PCN were more likely to require ICU admission (odds ratio: 3.23, 95% confidence interval [ CI ]: 1.24–8.41, P = 0.016), and demonstrated longer length of hospital stay (β: 0.47, 95% CI : 0.20–0.74, P = 0.001), even when adjusting for age, APACHE II score, and C harlson C omorbidity I ndex score. After resolution of sepsis, patients treated with PCN were more likely to be treated definitively with a percutaneous approach, while patients treated with JJ stent placement were more likely to be treated ureteroscopically.Conclusions Both JJ stent placement and PCN drainage appear effective. Patients with larger stones and who are more acutely ill are more likely to be treated with PCN . Additional randomized clinical trials of adequate power are warranted to define the optimum management of these often complex cases.