Canadian Urological Association guideline: Management of ureteral calculi

Lee, Jason Y.; Andonian, Sero; Bhojani, Naeem; Bjazevic, Jennifer; Chew, Ben H.; De, Shubha; Elmansy, Hazem; Lantz-Powers, Andrea G.; Pace, Kenneth T.; Schuler, Trevor; Singal, Rajiv K.; Ordon, Michael

doi:10.5489/cuaj.7581

“…The mean age of patients in both groups was 59.36 years, and advanced age as a risk factor for urosepsis. Effective early goal-directed therapy for urosepsis involves broad-spectrum intravenous antibiotics, supportive treatment, and source control [13]. Surgical drainage of the infection source has been shown to reduce the mortality rate of urosepsis from 19.2-8.82% [6].…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study of Flexible Ureteroscopic Lithotripsy for Upper Urinary Tract Stones in Patients with Prior Urosepsis Following Emergency Drainage via Retrograde Ureteral Stent or Percutaneous Nephrostomy

Sucai,

Xu,

Yuan

et al. 2023

Preprint

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Background Patients with urosepsis associated with upper urinary tract stones require further stone management after emergency drainage. Objective To evaluate the safety and efficacy of elective flexible ureteroscopic lithotripsy (F-URSL) for upper urinary tract stones in patients with prior urosepsis who have undergone emergency drainage using retrograde ureteral stent(RUS) or percutaneous nephrostomy (PCN). Method Between January 2017 and December 2021, clinical data were collected for 102 patients who underwent elective F-URSL following emergency drainage for urosepsis caused by upper ureteral or renal stones. The patients were categorized into two groups based on the drainage method used: the RUS group and the PCN group. The collected data included patient demographics, stone parameters, infection recovery after emergency drainage, and clinical outcomes post F-URSL. Subsequently, the data underwent statistical analysis. Results A total of 102 patients were included in the statistical analysis, with 58 (56.86%) in the RUS group and 44 (43.14%) in the PCN group. Among the patients, 84 (82.35%) were female and 18 (17.65%) were male, with an average age of 59.36 years. Positive urine cultures were observed in 71 (69.61%) patients. Successful drainage was achieved in all patients in both groups, and there were no significant differences in the time required for normalization of white blood cell count (WBC) and body temperature following drainage. Additionally, all patients underwent F-URSL successfully, and no statistically significant differences were observed between the two groups in terms of operative time, stone-free rates, postoperative fever, and postoperative hospital stay. Conclusion Both RUS and PCN have been established as effective approaches for managing urosepsis caused by upper urinary tract stones. Furthermore, the impact of these two drainage methods on the subsequent management of stones through elective F-URSL has shown consistent outcomes.

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“…The mean age of patients in both groups was 59.36 years, and advanced age as a risk factor for urosepsis. Effective early goal-directed therapy for urosepsis involves broad-spectrum intravenous antibiotics, supportive treatment, and source control [ 13 ]. Surgical drainage of the infection source has been shown to reduce the mortality rate of urosepsis from 19.2 to 8.82% [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

A comparative study of flexible ureteroscopic lithotripsy for upper urinary tract stones in patients with prior urosepsis following emergency drainage via retrograde ureteral stent or percutaneous nephrostomy

Liao,

Xu,

Yuan

et al. 2023

BMC Urol

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Background Patients with urosepsis associated with upper urinary tract stones require further stone management after emergency drainage. Objective To evaluate the safety and efficacy of elective flexible ureteroscopic lithotripsy (F-URSL) for upper urinary tract stones in patients with prior urosepsis who have undergone emergency drainage using retrograde ureteral stent(RUS) or percutaneous nephrostomy (PCN). Method Between January 2017 and December 2021, clinical data were collected for 102 patients who underwent elective F-URSL following emergency drainage for urosepsis caused by upper ureteral or renal stones. The patients were categorized into two groups based on the drainage method used: the RUS group and the PCN group. The collected data included patient demographics, stone parameters, infection recovery after emergency drainage, and clinical outcomes post F-URSL. Subsequently, the data underwent statistical analysis. Results A total of 102 patients were included in the statistical analysis, with 58 (56.86%) in the RUS group and 44 (43.14%) in the PCN group. Among the patients, 84 (82.35%) were female and 18 (17.65%) were male, with an average age of 59.36 years. Positive urine cultures were observed in 71 (69.61%) patients. Successful drainage was achieved in all patients in both groups, and there were no significant differences in the time required for normalization of white blood cell count (WBC) and body temperature following drainage. Additionally, all patients underwent F-URSL successfully, and no statistically significant differences were observed between the two groups in terms of operative time, stone-free rates, postoperative fever, and postoperative hospital stay. Conclusion Both RUS and PCN have been established as effective approaches for managing urosepsis caused by upper urinary tract stones. Furthermore, the impact of these two drainage methods on the subsequent management of stones through elective F-URSL has shown consistent outcomes.

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“…x-ray scan as the initial imaging modality for acute ureteral stones (strong recommendation, level 1 evidence). 7 The guideline authors note that, in most cases, ultrasound imaging and noncontrast computed tomography result in equivalent clinical outcomes. The addition of a KUB x-ray scan to ultrasound imaging improves the sensitivity of detection: combining KUB ultrasound and x-ray scan results in sensitivity ranging from 79% to 100% and specificity up to 100%.…”

Section: The Canadian Urological Association Recommends Ultrasonograp...mentioning

confidence: 99%

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O’Toole

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2022

Can Fam Physician

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Canadian Urological Association guideline: Management of ureteral calculi

Abstract: The authors would like to thank Simon Czajkowski, MSc (Phys), MBE, for his assistance in collating and synthesizing the many references in this document. They also thank Robin Parker, MLIS, PhD(c), for her assistance in conducting the literature search for the section on SWL.

Cited by 12 publications

References 233 publications

A Comparative Study of Flexible Ureteroscopic Lithotripsy for Upper Urinary Tract Stones in Patients with Prior Urosepsis Following Emergency Drainage via Retrograde Ureteral Stent or Percutaneous Nephrostomy

A Comparative Study of Flexible Ureteroscopic Lithotripsy for Upper Urinary Tract Stones in Patients with Prior Urosepsis Following Emergency Drainage via Retrograde Ureteral Stent or Percutaneous Nephrostomy

A comparative study of flexible ureteroscopic lithotripsy for upper urinary tract stones in patients with prior urosepsis following emergency drainage via retrograde ureteral stent or percutaneous nephrostomy

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