Safety and efficacy of ureteroscopy after obstructive pyelonephritis treatment

Kanno, Toru; Matsuda, Ayumu; Sakamoto, Hiromasa; Higashi, Yoshihito; Yamada, Hitoshi

doi:10.1111/iju.12060

Cited by 19 publications

(8 citation statements)

References 19 publications

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“…However, the irrigation significantly increases the intrarenal pressure, which leads to intrarenal, pyelovenous, and pyelolymphatic bacterial infection absorption. In Kanno et al's study, [ 7 ] although all patients with obstructive pyelonephritis experienced 7 days of preoperative drainage, the incidence of sepsis was still up to 8% after URL. In another study, patients underwent flexible ureteroscopy after percutaneous nephrostomy tube placement, while the postoperative sepsis rate was up to 10%.…”

Section: Discussionmentioning

confidence: 99%

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Urgent laparoscopic ureterolithotomy for proximal ureter stones accompanied with obstructive pyelonephritis

Yang

Peng

et al. 2017

Medicine

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To evaluate the safety and efficacy of retroperitoneal laparoscopic ureterolithotomy (RLU) in the treatment of proximal ureteral stones accompanied with obstructive pyelonephritis without preoperative drainage.We retrospectively reviewed 21 cases of proximal ureteral stones with infected kidney undergoing RLU between July 2013 and September 2016. Stone-induced obstructive infected hydronephrosis was diagnosed using blood and urine tests and imaging modalities. Empirical effective broad spectrum antibiotic therapy was initiated immediately, and then urgent RLU was performed without preoperative drainage. During the surgical procedure, infected urine was also aspirated before stone was removed. Preoperative, intraoperative, and postoperative clinical data were collected.Operations were performed successfully without open conversion or blood transfusion. The mean operation time was 69.3 ± 12.33 minutes. For all the patients, the level of plasma procalcitonin decreased after RLU. The mean hospital stay duration was 6.4 ± 1.54 days. No septic shock or other severe complications occurred. By discharge, the body temperature and hemogram of each patient returned to normal. A 100% stone-free rate was achieved.Our study suggests that RLU is a potentially safe and effective method to treat proximal ureteral stones accompanied with obstructive pyelonephritis without any need of preoperative drainage.

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Section: Discussionmentioning

confidence: 99%

“…In addition, unfortunately, despite long-term preoperative drainage and even negative reexamined urine culture, the widely used mini-invasive techniques failed to completely avoid the following urosepsis. [ 7 , 8 ] The treatment of UUT stones accompanied with obstructive pyelonephritis remains challenging for urologists.…”

Section: Introductionmentioning

confidence: 99%

Urgent laparoscopic ureterolithotomy for proximal ureter stones accompanied with obstructive pyelonephritis

Yang

Peng

et al. 2017

Medicine

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“…These manoeuvres can offer a prompt relief of pain, sepsis, and uraemia and they are usually followed by definitive treatment either by URS or ESWL [9] . URS is safe, effective and seems to be the superior treatment option compared with ESWL for treating ureteric stones after initial decompression of acutely obstructed kidneys [10] . After decompression of the obstructed kidney and general stabilisation of the condition, re-evaluation of the stone location and characteristics should be done for planning of the next step in treatment.…”

Section: Discussionmentioning

confidence: 99%

After urgent drainage of an obstructed kidney by internal ureteric stenting; is ureteroscopic stone extraction always needed?

Taha

Elshal

Zahran

et al. 2015

Arab Journal of Urology

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ObjectivesTo assess the probability of spontaneous stone passage and its predictors after drainage of obstructed kidney by JJ stent, as insertion of an internal ureteric stent is often used for renal drainage in cases of calcular ureteric obstruction.Patients and methodsBetween January 2011 and June 2013, patients for whom emergent drainage by ureteric stents were identified. The patients’ demographics, presentation, and stone characteristics were reviewed. The primary endpoint for this study was stone-free status at the time of stent removal, where all patients underwent non-contrast spiral computed tomography (NCCT) before stent removal. Ureteroscopic stone extraction was performed for CT detectable ureteric stones at the time of stent removal. Potential factors affecting the need for ureteroscopic stone extraction at the time of stent removal were assessed using univariate and multivariate statistical analyses.ResultsEmergent ureteric stents were undertaken in 196 patients (112 males, 84 females) with a mean (SD) age of 53.7 (16.2) years, for renal obstruction drainage. At the time of stent removal, 83 patients (42.3%) were stone free; with the remaining 113 patients (57.7%) undergoing ureteroscopic stone extraction. On multivariate analysis, stone width [odds ratio (OR) 15.849, 95% confidence interval (CI) 2.83; P = 0.002) and radio-opaque stones (OR 12.035, 95% CI 4.65; P < 0.001) were independent predictors of the need for ureteroscopic stone extraction at the time of stent removal.ConclusionSpontaneous ureteric stone passage is possible after emergent drainage of an obstructed kidney by ureteric stenting. Stone opacity, larger stone width, and positive preoperative urine culture are associated with a greater probability of requiring ureteroscopic stone extraction after emergent drainage by ureteric stenting.

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“…Emergency drainage is a priority treatment in these patients, and the definitive treatment for lithiasis is performed thereafter. However, the length of wait time before definitive treatment is performed has not been defined [11].…”

Section: Discussionmentioning

confidence: 99%

Early ureteroscopic treatment in patients with urosepsis associated with ureteral calculi is a safe approach. A pilot study

Astroza¹,

Sarras²,

Salvadó

et al. 2019

Cent european J Urol

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Introduction Emergency drainage of the urinary tract is the first necessary approach in patients with urosepsis secondary to obstructive ureteral calculi. The appropriate waiting time before definitive treatment has not been determined. We hypothesized that early ureteroscopic treatment after the patient has been stabilized is as safe as deferred treatment. Material and methods A pilot study was developed between November 2013 and September 2017. Patients with urosepsis associated with ureteral calculi were included. All the patients were initially decompressed with a ureteral stent. Patients were randomized to early ureteroscopic treatment (EUT), who received definitive treatment during the initial hospitalization, or deferred ureteroscopic treatment (DUT), that received definitive treatment in a second hospitalization. The stone location and size, sex distribution, age, APACHE II score, length of hospital stay, days with ureteral catheter and complications were registered. Statistical analysis was performed using Stata 12.0. Results A total of 13 patients were included in the EUT group and 13 in the DUT group. No differences in sex distribution, stone location, APACHE II score, age, stone size and time between admission and urinary drainage were found. Total length of hospital stay and complications were also similar between both groups. A statistically significant difference was found in terms of duration of antibiotic treatment (p = 0.04) and total days with double J catheter (p = 0.0009). Conclusions EUT for ureteral stone is as safe as DUT in patients admitted with urosepsis secondary to ureterolithiasis. EUT is associated with a shorter period of ureteral stent and it is not associated with an increase in complications.

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Safety and efficacy of ureteroscopy after obstructive pyelonephritis treatment

Cited by 19 publications

References 19 publications

Urgent laparoscopic ureterolithotomy for proximal ureter stones accompanied with obstructive pyelonephritis

Urgent laparoscopic ureterolithotomy for proximal ureter stones accompanied with obstructive pyelonephritis

After urgent drainage of an obstructed kidney by internal ureteric stenting; is ureteroscopic stone extraction always needed?

Early ureteroscopic treatment in patients with urosepsis associated with ureteral calculi is a safe approach. A pilot study

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