How to manage sepsis associated with ureteral calculi?

Excerpt

In this interesting study the authors compared the efficacy and complication rates of emergent ureterorenoscopy (eURS) and percutaneous nephrostomy (PN) tube placement for obstructed ureteral stones [1]. The authors have done a prospective randomized trial in a much debated topic. In the study retrograde internal ureteral stent placement or percutaneous nephrostomy (PCN) is suggested in the guidelines because none of them have superiority to the other. I congratulate the authors for successful treatment the sepsis disease likely to go to multi-organ deficiency, septic shock and even to death. Interestingly they can treat the disease without occurring pyelo interstitial reflux-related complications. Currently, infected obstructive collecting system treatment is controversial. URS after decompression for ureteral stone-related sepsis has similar success, but higher complication rates, longer hospital length of stay, and longer course of postoperative antibiotics [2]. Pearle et al. mentioned that PN and retrograde ureteral catheterization effectively relieve obstruction and infection, but they need one more procedure to get rid of stone [3]. Goldsmith et al. found both JJ stent placement and PN drainage appear effective in sepsis patients [4]. Furthermore, they adviced PN for the patients with larger stones and who are more acutely ill. …