title: Ureteroscopic management of sepsis associated with ureteral stone impaction: is it still contraindicated?
abstract: BACKGROUND
  Retrograde decompression is generally not advocated for patients with sepsis owing to ureteral obstruction by stone impaction, and the initial treatment of choice is percutaneous nephrostomy (PCN). We report our experience with the treatment of urosepsis with retrograde ureteroscopy (URS) instead of PCN drainage.
  
  
  METHODS
  Fifty-six consecutive patients diagnosed with ureteral stone-related sepsis received URS as primary treatment at our institution. Patients with uncontrollable sepsis underwent emergent URS and hemodynamically stable patients underwent elective URS within two days of diagnosis.
  
  
  RESULTS
  URS was successful in 53 (94.6%) of the 56 patients. PCN was performed in the 3 cases of URS failure. Internal ureteral stenting was performed in 48 patients. Secondary procedures were performed in 10 (18.9%) patients. Twenty-six patients suffered from postoperative fever for an average of 1.6 days (range 1-4 days). There were no anesthesia-related morbidities, postoperative exacerbations of the clinical condition, or postoperative deaths. The median length of hospital stay was 7 days (range 3-94 days).
  
  
  CONCLUSIONS
  PCN drainage is the standard treatment of sepsis associated with ureteral stone obstruction. However, our results show that URS can be safely and successfully performed by skilled endourologists in select clinical situations.
authors.affiliation: Department of Urology, Mackay Memorial Hospital, and Mackay Medicine, Nursing and Management College, Taipei, Taiwan.
authors.forename: Jong-Ming
authors.initials: JM
authors.lastname: Hsu
authors.forename: Marcelo
authors.initials: M
authors.lastname: Chen
authors.forename: Wen-Chou
authors.initials: WC
authors.lastname: Lin
authors.forename: Huang-Kuang
authors.initials: HK
authors.lastname: Chang
authors.forename: Stone
authors.initials: S
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000150:complications / Q000601:surgery*; D014517:Ureteral Obstruction / Q000209:etiology / Q000601:surgery*; D018666:Ureteroscopy