Outcomes of elective ureteroscopy and stone treatment in patients with prior urosepsis and emergency drainage
BAUS ePoster online library. Jones P. Jun 26, 2018; 211308
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Patrick Jones
Patrick Jones
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Abstract
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Introduction: Urological guidelines recommend emergency drainage for urosepsis in infected obstructed kidney secondary to stone disease. However, since the fate of elective ureteroscopy (URS) in these patients is largely unknown, we look at the outcomes of stone management in this group.

Material and Methods: Over a period of 6-years (March 2012-December 2017), we identified all patients with prior urosepsis and emergency drainage who underwent elective URS for stone treatment. They were seen in a dedicated pre-assessment clinic with antibiotics as per protocol or microbiologist.

Results: A total of 76 patients underwent 82 procedures (6 bilateral URS) with a male:female ratio of 1:2 and a mean age of 75 years(range 14-86 years). Urosepsis was diagnosed on admission with 27(36%) admitted to ICU and a positive urine culture in 26(34%). The mean WBC count and CRP was 14.3(2.7-42) and 199(1-425) respectively. Emergency drainage was achieved via ureteric stent(63, 83%) and nephrostomy(13, 17%).
The mean single and overall stone size was 8.6 mm (2-23 mm) and 10.8 mm (2-32 mm) respectively with 45 ureteric stones(59%), 17 ureteric and renal stones (22%) and 14 with multiple stones in the urinary tract (19%). With a mean operating time of 42 minutes (5-129 minutes), the stone free rate(SFR) was 97%, and 60(79%) were discharged within same day. Three patients (4%) developed complications(urosepsis), two Clavien II that needed intravenous antibiotics and one Clavien IV that needed ICU admission and treatment, subsequently discharged home.

Conclusion: Planned elective ureteroscopy in patients with prior urosepsis and emergency drainage achieves an excellent outcome with good SFR and low complication rates.
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