Percutaneous nephrostomy versus ureteroscopic management of sepsis associated with ureteral stone impaction: a randomized controlled trial

详细信息    查看全文

• 作者：Chung-Jing Wang ; Chi-Sen Hsu ; Hung-Wen Chen ; Chien-Hsing Chang…
• 关键词：Ureteral stones ; Sepsis ; Percutaneous nephrostomy ; Ureteroscope
• 刊名：Urological Research
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：44
• 期：5
• 页码：415-419
• 全文大小：396 KB
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Urology and Andrology
  Nephrology
  Medical Biochemistry
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1434-0879
• 卷排序：44

文摘

A randomized trial was conducted prospectively to evaluate the efficacy, related complications, and convalescence of emergent retrograde ureteroscopic management, instead of percutaneous nephrostomy for decompression of the collecting system in cases of sepsis associated with ureteral stone obstruction. A total of 107 patients undergoing ureteroscopic stone manipulation for ureteral stones completed the study protocol, 53 patients in the percutaneous nephrostomy group, and 54 patients in the emergent retrograde ureteroscopic management group. The primary end point was the time to normalization of WBC of 10,000/mm or less and temperature of 37.4 °C or less. The second end point was the comparison analgesic consumption, length of stay, and related complications. Statistical analysis was performed using SPSS® version 14.0.1. The Mann–Whitney U test, Chi square test, and fisher’s exact test was used as appropriate. The length of hospital stay (days) was 10.25 ± 3.53 and 8.24 ± 2.77 in the percutaneous nephrostomy group and emergent retrograde ureteroscopic management group, respectively, with significant difference (Table 2). However, patients in the emergent retrograde ureteroscopic management group had a significantly higher rate of s body temperature (°C). Meanwhile, the analgesic consumptions are 31.51 ± 11.16 and 40.00 ± 14.54 in the percutaneous nephrostomy group and emergent retrograde ureteroscopic management group, respectively, with significant difference. Our results show that it can be effectively and safely managed by retrograde ureteroscopic management combined with strong antibiotics in select clinical situations. Ureteroscopic management should no longer be considered a contraindication for the treatment of patients with sepsis associated with obstructing ureteral stones