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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.

Publication ,  Journal Article
Goldsmith, ZG; Oredein-McCoy, O; Gerber, L; Bañez, LL; Sopko, DR; Miller, MJ; Preminger, GM; Lipkin, ME
Published in: BJU Int
July 2013

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 Charlson Comorbidity Index 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.

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Published In

BJU Int

DOI

EISSN

1464-410X

Publication Date

July 2013

Volume

112

Issue

2

Start / End Page

E122 / E128

Location

England

Related Subject Headings

  • Young Adult
  • Urology & Nephrology
  • Urolithiasis
  • Ureteral Obstruction
  • Ureter
  • Treatment Outcome
  • Time Factors
  • Stents
  • Sepsis
  • Retrospective Studies
 

Citation

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Goldsmith, Z. G., Oredein-McCoy, O., Gerber, L., Bañez, L. L., Sopko, D. R., Miller, M. J., … Lipkin, M. E. (2013). Emergent ureteric stent vs percutaneous nephrostomy for obstructive urolithiasis with sepsis: patterns of use and outcomes from a 15-year experience. BJU Int, 112(2), E122–E128. https://doi.org/10.1111/bju.12161
Goldsmith, Zachariah G., Olugbemisola Oredein-McCoy, Leah Gerber, Lionel L. Bañez, David R. Sopko, Michael J. Miller, Glenn M. Preminger, and Michael E. Lipkin. “Emergent ureteric stent vs percutaneous nephrostomy for obstructive urolithiasis with sepsis: patterns of use and outcomes from a 15-year experience.BJU Int 112, no. 2 (July 2013): E122–28. https://doi.org/10.1111/bju.12161.
Goldsmith ZG, Oredein-McCoy O, Gerber L, Bañez LL, Sopko DR, Miller MJ, et al. Emergent ureteric stent vs percutaneous nephrostomy for obstructive urolithiasis with sepsis: patterns of use and outcomes from a 15-year experience. BJU Int. 2013 Jul;112(2):E122–8.
Goldsmith, Zachariah G., et al. “Emergent ureteric stent vs percutaneous nephrostomy for obstructive urolithiasis with sepsis: patterns of use and outcomes from a 15-year experience.BJU Int, vol. 112, no. 2, July 2013, pp. E122–28. Pubmed, doi:10.1111/bju.12161.
Goldsmith ZG, Oredein-McCoy O, Gerber L, Bañez LL, Sopko DR, Miller MJ, Preminger GM, Lipkin ME. Emergent ureteric stent vs percutaneous nephrostomy for obstructive urolithiasis with sepsis: patterns of use and outcomes from a 15-year experience. BJU Int. 2013 Jul;112(2):E122–E128.
Journal cover image

Published In

BJU Int

DOI

EISSN

1464-410X

Publication Date

July 2013

Volume

112

Issue

2

Start / End Page

E122 / E128

Location

England

Related Subject Headings

  • Young Adult
  • Urology & Nephrology
  • Urolithiasis
  • Ureteral Obstruction
  • Ureter
  • Treatment Outcome
  • Time Factors
  • Stents
  • Sepsis
  • Retrospective Studies