Optimal Method of Urgent Decompression of the Collecting System for Obstruction and Infection Due to Ureteral Calculi

Pearle, Margaret S.; Pierce, H. Lyle; Miller, George; Summa, James A.; MUTZ, JACQUELINE M.; Petty, Beth A.; Roehrborn, Claus G.; Kryger, John V.; Nakada, Stephen Y.

doi:10.1016/s0022-5347(01)62511-4

Cited by 246 publications

(114 citation statements)

References 24 publications

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“…The disadvantages of PCN include a longer procedure, patient discomfort, and morbidity. Whilst clinical outcome with both ureteric catheterisation and PCN for obstructive urolithiasis has been essentially similar [13], PCN placement has been found to be less expensive [14]. Availability of an interventional radiologist and longer waiting time for operating room favour PCN placement [15].…”

Section: Discussionmentioning

confidence: 99%

Predictors of renal recovery in renal failure secondary to bilateral obstructive urolithiasis

Rajadoss

Berry

Rebekah

et al. 2016

Arab Journal of Urology

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ObjectivesTo identify factors predicting renal recovery in patients presenting with renal failure secondary to bilateral obstructing urolithiasis.Patients and methodsData from electronic records of consecutive adult patients presenting with bilateral obstructing urolithiasis between January 2007 and April 2011 were retrieved. Ultrasonography of the abdomen, and kidney, ureter, bladder (KUB study) X-ray or abdominal non-contrast computed tomography confirmed the diagnosis. Interventional radiologists placed bilateral nephrostomies. Definitive intervention was planned after reaching nadir creatinine. Renal recovery was defined as nadir creatinine of ⩽2 mg/dL.ResultsIn all, 53 patients were assessed, 50 (94.3%) were male, and 18 (33.9%) were aged ⩽40 years. Renal recovery was achieved in 20 patients (37.7%). A symptom duration of ⩽25 days (P < 0.01), absence of hypertension (P = 0.018), maximum renal parenchymal thickness of >16.5 mm (P = 0.001), and haemoglobin >9.85 g/dL (P < 0.01) were significant on unadjusted analysis. Symptom duration of ⩽25 days alone remained significant after adjusted analysis. Symptom duration of ⩽25 days (hazard ratio (HR) 13.83, 95% confidence interval (CI) 4.52–42.26; P < 0.01), parenchymal thickness of ⩾16.5 mm (HR 5.91, 95% CI 1.94–17.99; P = 0.002), and absence of hypertension (HR 9.99, CI 95% 1.32–75.37; P = 0.026) were significantly related to time to nadir creatinine. Symptom duration of ⩽25 days (HR 17.44, 95% CI 2.48–122.79; P = 0.004) alone remained significant after adjusted analysis. A symptom duration of ⩽25 days (P = 0.007) was 22-times more likely to indicate renal recovery.ConclusionsShorter symptom duration (⩽25 days) is predictive of renal recovery in renal failure secondary to bilateral obstructive urolithiasis.

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Section: Discussionmentioning

confidence: 99%

Predictors of renal recovery in renal failure secondary to bilateral obstructive urolithiasis

Rajadoss

Berry

Rebekah

et al. 2016

Arab Journal of Urology

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“…In cases of complicated renal colic it is necessary to divert the urine; this can be achieved by using of a double J or ureteral stent, or by percutaneous nephrostomy [5], with subsequent use of ESWL to fragment the stone. A mean stone–free rate of 77.4% (range 63–100%) has been estimated after ESWL has been used in cases of proximal ureteral stone; however, multiple sessions are required in 10% of cases [6].…”

Section: Introductionmentioning

confidence: 99%

Original Paper Double J stent reduces the efficacy of extracorporeal shock wave lithotripsy in the treatment of lumbar ureteral stones

Pettenati¹,

Fegoun²,

Dominique³

et al. 2013

CEJU

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IntroductionWe evaluated the effect of the presence of a double J stent on the efficacy of extracorporeal shock wave lithotripsy (ESWL) in the treatment of lumbar ureteral stones.Material and methodsBetween January 2007 and February 2012, we performed a retrospective cohort study. Forty–four patients were treated by ESWL for lumbar ureteral stones and included into two groups for the analysis: group 1, non–stented (n = 27) and group 2, stented patients (n = 17). Treatment efficacy was evaluated by abdominal X–ray or CT–scan at 1 month. Stone–free patients and those with a residual stone ≤4 mm were considered to be cured.ResultsMean stone size and density in groups 1 and 2 were 8.2mm/831HU, and 9.7 mm/986HU respectively. Both groups were comparable for age, BMI, stone size and density, number, and power of ESWL shots given. The success rates in groups 1 and 2 where 81.5% and 47.1%, respectively (p = 0.017). There was no difference between the groups for stones measuring 8 mm or less (p = 0.574). For stones >8 mm, the success rates were respectively 76% and 22.2% for groups 1 and 2 (p = 0.030). Logistic regression analysis revealed a higher failure rate when a double J stent was associated with a stone >8 mm (p = 0.033).ConclusionsThe presence of a double J stent affects the efficacy of ESWL in the treatment of lumbar ureteral stones. This effect is significant for stones >8 mm. Ureteroscopy should be considered as the first–line treatment in such patients.

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“…However, of the decompressive interventions 98.8% were performed by a urologist, leaving only a small proportion impacted by the availability of an interventional radiologist. As prior prospective studies have demonstrated no difference in patient outcomes with percutaneous nephrostomy tube placement compared to retrograde ureteral stent placement, 20 in patients with indications for urgent intervention (eg infection and an obstructed upper tract) the proper management strategy remains the intervention that can be performed most expeditiously.…”

Section: Discussionmentioning

confidence: 99%

Early Intervention during Acute Stone Admissions: Revealing “The Weekend Effect” in Urological Practice

et al. 2016

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Purpose Obstructing nephrolithiasis is a common condition that can require urgent intervention. In this study we analyze patient factors that contribute to delayed intervention during acute stone admission. Materials and Methods We retrospectively reviewed the HCUP SID (Healthcare Cost and Utilization Project State Inpatient Database) for Florida and California from 2007 to 2011. Patients who were admitted urgently with nephrolithiasis and an indication for decompression (urinary tract infection, acute renal insufficiency and/or sepsis) were included in the study. Intervention was timely or delayed, defined as a procedure that occurred within or after 48 hours, respectively. Adjusted multivariate models were fit to assess factors that predicted a delayed procedure as well as mortality. Results Overall 10,301 patients were admitted urgently for nephrolithiasis with indications for decompression. Early intervention occurred in 6,689 patients (65%) and was associated with a decrease in mortality (11, 0.16%), compared to delayed intervention (17 of 3,612, 0.47%, p=0.002). On multivariate analysis timely intervention significantly decreased the odds of inpatient mortality (OR 0.43, p=0.044). Weekend day admission significantly influenced time to intervention, decreasing patient odds of timely intervention by 26% (p <0.001). Other factors decreasing patient odds of timely intervention included non-Caucasian race and nonprivate insurance. Presenting medical diagnoses of urinary tract infection, sepsis and acute renal failure did not appear to influence time to intervention. Conclusions Delayed operative intervention for acute nephrolithiasis admissions with indications for decompression results in increased patient mortality. Nonmedical factors such as the “weekend effect,” race and insurance provider exerted the greatest influence on the timing of intervention.

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Optimal Method of Urgent Decompression of the Collecting System for Obstruction and Infection Due to Ureteral Calculi

Cited by 246 publications

References 24 publications

Predictors of renal recovery in renal failure secondary to bilateral obstructive urolithiasis

Predictors of renal recovery in renal failure secondary to bilateral obstructive urolithiasis

Original Paper Double J stent reduces the efficacy of extracorporeal shock wave lithotripsy in the treatment of lumbar ureteral stones

Early Intervention during Acute Stone Admissions: Revealing “The Weekend Effect” in Urological Practice

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