Ureteroscopic Management of Sepsis Associated with Ureteral Stone Impaction: Is It Still Contraindicated?

Hsu, Jong-Ming; Chen, Marcelo; Lin, Wen-Chou; Chang, Huang-Kuang; Yang, Stone

doi:10.1159/000084430

Cited by 21 publications

(15 citation statements)

References 11 publications

(7 reference statements)

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“…Clinically there seems to be no significant difference between ureteral stent and percutaneous nephrostomy for the control of ureteral calculi [35,36]. In parallel with the urological control of the septic focus, further intensive medical treatment encompassing adjunctive sepsis therapy such as cardio-vascular support, mechanical ventilation, organ substitution, or management of endocrine insufficiency should be instigated [37,38].…”

Section: Advanced Managementmentioning

confidence: 99%

Therapeutic challenges of urosepsis

Wagenlehner

Pilatz

Naber

et al. 2008

Eur J Clin Investigation

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Urosepsis accounts for approximately 25% of all sepsis cases and may develop from a community or nosocomial acquired urinary tract infection (UTI). The underlying UTI is almost exclusively a complicated one with involvement of parenchymatous urogenital organs (e.g. kidneys, prostate). In urosepsis, as in other types of sepsis, the severity of sepsis depends mostly upon the host response. The treatment of urosepsis comprises four major aspects: Early goal directed therapy, early optimal pharmacodynamic exposure to antimicrobials, early control of the complicating factor in the urinary tract and specific sepsis therapy. Following these prerequisites there appear two major challenges that need to be addressed:Firstly, time from admission to therapy is critical; the shorter the time to effective treatment, the higher the success rate. This aspect has to become incorporated into the organisational process. Secondly, adequate initial antibiotic therapy has to be insured. This goal implies however, a wide array of measures to ensure rational antibiotic policy. Both challenges are best targeted if an interdisciplinary approach at any level of the process is established, encompassing urologists, intensive care specialists, radiologists, microbiologists and clinical pharmacologists working tightly together at any time.

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Section: Advanced Managementmentioning

confidence: 99%

Therapeutic challenges of urosepsis

Wagenlehner

Pilatz

Naber

et al. 2008

Eur J Clin Investigation

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“…These results, combined with our own, suggest that URS can be carried out approximately 10 days after fever has subsided. That said, there are reports that URS can be safely carried out even before sepsis has been resolved . Therefore, further study is required to determine optimal timing of URS for septic patients with obstructing stones.…”

Section: Discussionmentioning

confidence: 99%

“…That said, there are reports that URS can be safely carried out even before sepsis has been resolved. 16 Therefore, further study is required to determine optimal timing of URS for septic patients with obstructing stones.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of ureteroscopy after obstructive pyelonephritis treatment

et al. 2013

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Abbreviations & AcronymsObjectives: An obstructed, infected kidney combined with ureteral stones can be lethal, and requires urgent drainage and complete stone removal. However, the optimal method of stone removal, and its safety and efficacy have yet to be conclusively established. The aim of this study was to determine the safety and efficacy of carrying out ureteroscopy after kidney drainage for septic patients with obstructing stones. Methods: From January 2004 to September 2011, 88 patients underwent stone removal by either ureteroscopy (n = 48) or extracorporeal shock wave lithotripsy (n = 40) after drainage of obstructive pyelonephritis. Patients' characteristics were analyzed, and treatment outcomes between the ureteroscopy and extracorporeal shock wave lithotripsy groups were compared. The outcomes of ureteroscopy carried out during the same period between patients with preoperative obstructive pyelonephritis and those without were also compared. Results: Obstructed, infected kidneys were decompressed with retrograde ureteral stenting, except for two and three cases treated with nephrostomy in the ureteroscopy and extracorporeal shock wave lithotripsy groups, respectively. The severity of preoperative pyelonephritis was similar in both groups. Importantly, the success rate was 67.5% for extracorporeal shock wave lithotripsy and 98% for ureteroscopy (P < 0.001). Likewise, the retreatment and auxiliary procedure rates were significantly greater in the extracorporeal shock wave lithotripsy group than in the ureteroscopy group (90% vs 0% and 32.5% vs 2%, respectively). Furthermore, patients treated by ureteroscopy with or without preoperative pyelonephritis had similar stone-free and ureteroscopy complication rates (97% vs 93%, and 10% vs 12%). Conclusions: Ureteroscopy after drainage of an obstructed infected kidney can be a safe and effective option, as it seems to not be associated with an increased risk of complications.

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“…emergency drainage) and thereafter definitive elimination of the complicating factor. Clinically there seems to be no significant difference between ureteral stent and percutaneous nephrostomy for the control of ureteral calculi [53,54]. In parallel with the urological control of the septic focus adequate antimicrobial treatment has to be initiated.…”

Section: Diagnosis Of Urosepsismentioning

confidence: 99%