title: Percutaneous nephrostomy versus ureteroscopic management of sepsis associated with ureteral stone impaction: a randomized controlled trial.
abstract: A randomized trial was conducted prospectively to evaluate the efficacy, related complications, and convalescence of emergent retrograde ureteroscopic management, instead of percutaneous nephrostomy for decompression of the collecting system in cases of sepsis associated with ureteral stone obstruction. A total of 107 patients undergoing ureteroscopic stone manipulation for ureteral stones completed the study protocol, 53 patients in the percutaneous nephrostomy group, and 54 patients in the emergent retrograde ureteroscopic management group. The primary end point was the time to normalization of WBC of 10,000/mm or less and temperature of 37.4 °C or less. The second end point was the comparison analgesic consumption, length of stay, and related complications. Statistical analysis was performed using SPSS(®) version 14.0.1. The Mann-Whitney U test, Chi square test, and fisher's exact test was used as appropriate. The length of hospital stay (days) was 10.25 ± 3.53 and 8.24 ± 2.77 in the percutaneous nephrostomy group and emergent retrograde ureteroscopic management group, respectively, with significant difference (Table 2). However, patients in the emergent retrograde ureteroscopic management group had a significantly higher rate of s body temperature (°C). Meanwhile, the analgesic consumptions are 31.51 ± 11.16 and 40.00 ± 14.54 in the percutaneous nephrostomy group and emergent retrograde ureteroscopic management group, respectively, with significant difference. Our results show that it can be effectively and safely managed by retrograde ureteroscopic management combined with strong antibiotics in select clinical situations. Ureteroscopic management should no longer be considered a contraindication for the treatment of patients with sepsis associated with obstructing ureteral stones.
authors.affiliation: Division of Urology, Department of Surgery, Saint Martin De Porres Hospital, Chiayi, Taiwan, ROC. jing@stm.org.tw.
authors.forename: Chung-Jing
authors.initials: CJ
authors.lastname: Wang
authors.affiliation: Department of Infection, Saint Martin De Porres Hospital, Chiayi, Taiwan, ROC.
authors.forename: Chi-Sen
authors.initials: CS
authors.lastname: Hsu
authors.affiliation: Department of Emergency, Saint Martin De Porres Hospital, Chiayi, Taiwan, ROC.
authors.forename: Hung-Wen
authors.initials: HW
authors.lastname: Chen
authors.affiliation: Division of Urology, Department of Surgery, Saint Martin De Porres Hospital, Chiayi, Taiwan, ROC.
authors.forename: Chien-Hsing
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Division of Urology, Department of Surgery, Saint Martin De Porres Hospital, Chiayi, Taiwan, ROC.
authors.forename: Po-Chao
authors.initials: PC
authors.lastname: Tsai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D011446:Prospective Studies; D018805:Sepsis / Q000209:etiology*; D014514:Ureteral Calculi / Q000150:complications* / Q000628:therapy*; D014517:Ureteral Obstruction / Q000150:complications* / Q000628:therapy*; D018666:Ureteroscopy
keywords: Percutaneous nephrostomy; Sepsis; Ureteral stones; Ureteroscope