Category: Clinical Stones: Outcomes
Introduction & Objective :
Optimal management of obstructing ureteral stones with concomitant urinary tract infection (UTI) includes prompt decompression and antibiotics. There is a paucity of research to refute the use of retrograde pyelography (RGP) in these patients. Some urologists hypothesize that performing RGP prior to ureteral stent placement may cause pyelovenous backflow of infected material thereby worsening clinical outcomes. Our goal was to compare outcomes of patients who underwent RGP with those who did not at time of cystoscopy and stent placement for obstructing ureteral stones in the setting of a UTI.
We performed a retrospective chart review of all patients with an obstructing ureteral stone and associated UTI who presented to our institution between 2015 and 2017. Computed tomography images were evaluated for stone size and location. Operative reports were reviewed to determine whether each patient underwent a RGP during cystoscopy before ureteral stent placement. Demographics, perioperative information, postoperative intensive care unit (ICU) admission, and postoperative length of stay (LOS) were compared.
Results : Table 1 details patient characteristics and outcomes. A total of 72 patients were identified, 43 underwent RGP at the time of stent placement. The groups were similar in age, comorbidities, stone size, and stone location. Gender approached statistical significance (p=0.050). The groups were stratified by severity of infection at presentation including UTI without sepsis (n=15), sepsis (n=35), severe sepsis (n=11), and septic shock (n=11). Statistical analysis revealed no significant difference in postoperative ICU admissions (p=0.204) or mean LOS for patients with UTI without sepsis (p=0.783), sepsis (p=0.461), severe sepsis (p=0.662), and septic shock (p=0.648).
Retrograde pyelography was not associated with an increase in postoperative LOS or rate of ICU admission in our retrospective analysis, which suggests minimal impact on the severity of clinical condition. While RGP appears safe to perform before stent placement in the setting of a UTI, larger, prospective trials are warranted to further support this notion.
Joshua Palka– Urology Resident, Detroit Medical Center, Plymouth, Michigan
Zaid Farooq– Urology Resident, Detroit Medical Center, Detroit, Michigan
Barrett Anderson– Clinical Assistant Professor, Michigan State University / Detroit Medical Center, Detroit, Michigan