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

Abstract

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.

Tatalaksana Urosepsis: Sebuah Tinjauan Sistematis

“…43 Dalam penentuan waktu drainase awal, tidak terdapat perbedaan signifikan, early ureteroscopic treatment (EUT) sama baiknya dengan deferred ureteroscopic treatment (DUT), namun ada catatan perbedaan antara perbandingan tersebut, bahwa terdapat perbedaan signifikan pada durasi penggunaan antibiotik pada EUT vs DUT (17,2 hari vs 19,92 hari, p = 0,04) dan lama penggunaan kateter DJ stent (8,5 hari vs 18,38 hari, p = 0,0009). 44 Pada kasus urothelial carcinoma ketika pembedahan, radioterapi, dan kemoterapi sudah dipercaya tidak memberikan hasil yang signifikan, skleroterapi dengan target menurunkan urine output untuk menurunkan risiko perburukan infeksi pada obstruktif urosepsis, diikuti embolisasi arteri renalis, disebutkan bisa menjadi pilihan dalam mengurangi perburukan urosepsis, dan meregresi karsinoma dalam lima bulan, namun studi masih harus diteliti lebih lanjut, karena baru pertama kali dilakukan. 45…”