Are there any predictive risk factors for failure of ureteric stent in patients with obstructive urolithiasis with sepsis?

Abstract

PurposeTo compare patients with sepsis due to obstructive urolithiasis (Sep-OU) and underwent drainage by percutaneous nephrostomy (PCN) or a double-J (DJ)-ureteral stent and to identify predictive risk factors of DJ stent failure in these patients.Materials and MethodsWe reviewed our records from January 2013 to July 2018 and identified 286 adult patients with Sep-OU out of which 36 had bilateral involvement, thus total 322 renal units were studied. Urologic residents in training carried out both ureteral stenting and PCN tube placement. Demographic data and stone characteristics were recorded along with Charlson comorbidity index. For predicting risk factors of DJ stent failure, those variables that had a p-value <0.1 in univariate analysis were combined in a multinomial regression analysis model.ResultsThe patients with PCN placement were significantly older than those with DJ stent placement (p=0.001) and also had significant number of units with multiple calculi (p=0.018). PCN was also placed more frequently in those patients with a upper ureteric calculi (p<0.05). On multinomial regression analysis multiple calculi (p=0.014; odds ratio [OR], 4.878; 95% confidence interval [CI], 1.377–17.276) and larger calculi size (p=0.040; OR, 0.974; 95% CI, 0.950–0.999) were the significant predictors of DJ stent failure.ConclusionsIn patients with sepsis from obstructive urolithiasis due to larger and multiple calculi a PCN placement might be better suited although this data requires further prospective randomized studies to be extrapolated.

Percutaneous nephrostomy versus retrograde ureteral stent for acute upper urinary tract obstruction with urosepsis

“…This reflux might obscure vision during surgery, making it difficult. In clinical practice, patients with urosepsis caused by multiple or larger stones are likely to fail RUS [12]. Wang et al [13] suggested that the primary retrograde approach should be limited to experienced surgeons.…”

The Role of Antegrade Irrigation via Percutaneous Nephrostomy on Surgical Outcomes in Semirigid Ureteroscopy among Patients with Upper Ureteral Stones

“…In addition, when ureter stone(s) is large and/or multiple, there is a possibility of ureteral stenting failure. Pandey et al experienced 13.9% of ureteral stenting failure in obstructive stone management [23]. Thus, in cases of ureter stones with intractable pain, we prefer PCN placement rather than double-J stenting.…”

Which urinary drainage method is better tolerated in patients with hydronephrosis secondary to ureteral obstruction following onco-gynecology surgeries? A comparison of health-related quality of life

“…To our knowledge, this is the first study to compare the effects of each urinary diversion techniques on healthrelated quality of life in patients undergoing onco-gynecology surgery. The previous studies comparing two techniques have evaluated patients with hydronephrosis secondary to ureteral stones or pregnancy [7][8][9]. Most of these studies have investigated the effect of two methods on the improvement of ureteral obstruction and renal function.…”