2098 EMERGENT URETERAL STENT VERSUS NEPHROSTOMY FOR UROSEPTIC CALCULI: UTILIZATION AND OUTCOMES OVER 15 YEARS

Field: Medicine (Health Sciences)

You have accessJournal of UrologyStone Disease: Evaluation & Medical Management (I)1 Apr 20132098 EMERGENT URETERAL STENT VERSUS NEPHROSTOMY FOR UROSEPTIC CALCULI: UTILIZATION AND OUTCOMES OVER 15 YEARS Zachariah Goldsmith, Olugbemisola Oredein-Mccoy, Leah Gerber, Lionel Banez, Agnes Wang, Muhammad Iqbal, Gaston Astroza, Andreas Neisius, Ramy Youssef, David Sopko, Michael Miller, Glenn Preminger, and Michael Lipkin Zachariah GoldsmithZachariah Goldsmith DURHAM, NC More articles by this author , Olugbemisola Oredein-MccoyOlugbemisola Oredein-Mccoy DURHAM, NC More articles by this author , Leah GerberLeah Gerber DURHAM, NC More articles by this author , Lionel BanezLionel Banez DURHAM, NC More articles by this author , Agnes WangAgnes Wang DURHAM, NC More articles by this author , Muhammad IqbalMuhammad Iqbal DURHAM, NC More articles by this author , Gaston AstrozaGaston Astroza DURHAM, NC More articles by this author , Andreas NeisiusAndreas Neisius DURHAM, NC More articles by this author , Ramy YoussefRamy Youssef DURHAM, NC More articles by this author , David SopkoDavid Sopko DURHAM, NC More articles by this author , Michael MillerMichael Miller DURHAM, NC More articles by this author , Glenn PremingerGlenn Preminger DURHAM, NC More articles by this author , and Michael LipkinMichael Lipkin DURHAM, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2007AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Septic patients with obstructing stones require urgent collecting system decompression. We characterized the parameters determining utilization of double-J ureteral stent (JJ) versus percutaneous nephrostomy (PCN) in such patients, and determined whether outcomes differ between the two groups. METHODS A total of 130 patients with obstructing stones and systemic inflammatory response (SIRS)criteria were identified retrospectively from a large health system database, including a tertiary referral center and two community hospitals from 1995 to 2011. RESULTS 71 patients (55%) were treated with JJ and 59 (45%) with PCN. PCN patients had larger stones (10 vs. 7 mm, p = 0.031), and were more acutely ill as evident by higher APACHE scores (15 vs. 11, p = 0.036). PCN patients were more likely to require intensive care (OR: 3.23, 95% CI: 1.24-8.41, p = 0.016), and demonstrated longer length of hospital stay (Beta: 0.47, 95% CI: 0.20-0.74, p = 0.001), even when adjusting for age, APACHE score, and Charlson comorbidity index. The overall rate of failed procedures was 2.3% (3/130), with one in-hospital death (0.8%). Following resolution of sepsis, PCN patients were more likely to be treated with percutaneous nephrolithotomy, while JJ patients were more often treated ureteroscopically. CONCLUSIONS Patients with larger stones and who are more acutely ill are more likely to be treated with PCN. Both procedures appear effective, and this selection bias may explain the differential outcomes in this series. However, additional randomized clinical trials of adequate power are warranted to define optimal management of these patients. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189 Issue 4S April 2013 Page: e860 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Metrics Author Information Zachariah Goldsmith DURHAM, NC More articles by this author Olugbemisola Oredein-Mccoy DURHAM, NC More articles by this author Leah Gerber DURHAM, NC More articles by this author Lionel Banez DURHAM, NC More articles by this author Agnes Wang DURHAM, NC More articles by this author Muhammad Iqbal DURHAM, NC More articles by this author Gaston Astroza DURHAM, NC More articles by this author Andreas Neisius DURHAM, NC More articles by this author Ramy Youssef DURHAM, NC More articles by this author David Sopko DURHAM, NC More articles by this author Michael Miller DURHAM, NC More articles by this author Glenn Preminger DURHAM, NC More articles by this author Michael Lipkin DURHAM, NC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...