Urogenit Tract Infect.  2024 Dec;19(3):89-96. 10.14777/uti.2448018009.

Impact of the Timing of Percutaneous Nephrostomy on the Prognosis of Obstructive Urolithiasis With Sepsis: A Retrospective Cohort Study

• Yu JE
• Kim HJ
• Kim HW
• Chang YS
• Kim JB
• Koh DH

• KMID: 2564697
• DOI: http://doi.org/10.14777/uti.2448018009

Abstract

Purpose
The aim of this study was to investigate the prognostic impact of time to percutaneous nephrostomy (PCN) insertion on obstructive ureteral stones with sepsis.
Materials and Methods
Data were collected on patients who presented at our Emergency Department between 2017 and 2021 with obstructive uropathy due to urinary stones and underwent PCN insertion. Patients were stratified into 4 groups in accordance with the quick sepsis-related organ failure (qSOFA) score at presentation (<2 or ≥2) and time to PCN insertion (<4 hours or ≥4 hours) as follows: group 1, qSOFA < 2 and time to PCN insertion < 4 hours; group 2, qSOFA < 2 and time to PCN insertion ≥ 4 hours; group 3, qSOFA ≥ 2 and time to PCN insertion < 4 hours; group 4, qSOFA ≥ 2 and time to PCN insertion ≥ 4 hours. The prognostic impacts of the time to PCN insertion were compared between these groups
Results
The total cohort consisted of 96 patients, of whom 70 were classified as either group 1 or 2 (qSOFA < 2). Overall, 37 patients had a positive urine culture. The median time to PCN insertion was 218 minutes, and the median length of stay was 14 days. The hospitalization period was significantly shorter in group 3 than in group 4 (p=0.041).
Conclusions
A shorter length of stay was associated with more rapid PCN insertion in patients with obstructive uropathy and a high risk of sepsis.

Keyword

Urolithiasis; Sepsis; Percutaneous nephrostomy; Urinary diversion