Safety and efficacy of ureteroscopy after obstructive pyelonephritis treatment

• Published in: International journal of urology Vol. 20; no. 9; pp. 917 - 922
• Main Authors: Kanno, Toru, Matsuda, Ayumu, Sakamoto, Hiromasa, Higashi, Yoshihito, Yamada, Hitoshi
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01-09-2013
• Subjects: Acute Disease; Aged; Databases, Factual; Drainage; Female; Humans; Lithotripsy; Male; Middle Aged; Nephrostomy, Percutaneous; obstructive pyelonephritis; Pyelonephritis - epidemiology; Pyelonephritis - surgery; Pyelonephritis - therapy; Risk Factors; sepsis; Treatment Outcome; Ureteral Obstruction - epidemiology; Ureteral Obstruction - surgery; Ureteral Obstruction - therapy; ureteral stone; ureteroscopy; Ureteroscopy - adverse effects; Ureteroscopy - methods; Urinary Calculi - epidemiology; Urinary Calculi - surgery; Urinary Calculi - therapy; ureteral stone; obstructive pyelonephritis; ureteroscopy; sepsis
• ISSN: 0919-8172; 1442-2042
• DOI: 10.1111/iju.12060

Objectives
An obstructed, infected kidney combined with ureteral stones can be lethal, and requires urgent drainage and complete stone removal. However, the optimal method of stone removal, and its safety and efficacy have yet to be conclusively established. The aim of this study was to determine the safety and efficacy of carrying out ureteroscopy after kidney drainage for septic patients with obstructing stones.
Methods
From January 2004 to September 2011, 88 patients underwent stone removal by either ureteroscopy (n = 48) or extracorporeal shock wave lithotripsy (n = 40) after drainage of obstructive pyelonephritis. Patients' characteristics were analyzed, and treatment outcomes between the ureteroscopy and extracorporeal shock wave lithotripsy groups were compared. The outcomes of ureteroscopy carried out during the same period between patients with preoperative obstructive pyelonephritis and those without were also compared.
Results
Obstructed, infected kidneys were decompressed with retrograde ureteral stenting, except for two and three cases treated with nephrostomy in the ureteroscopy and extracorporeal shock wave lithotripsy groups, respectively. The severity of preoperative pyelonephritis was similar in both groups. Importantly, the success rate was 67.5% for extracorporeal shock wave lithotripsy and 98% for ureteroscopy (P < 0.001). Likewise, the retreatment and auxiliary procedure rates were significantly greater in the extracorporeal shock wave lithotripsy group than in the ureteroscopy group (90% vs 0% and 32.5% vs 2%, respectively). Furthermore, patients treated by ureteroscopy with or without preoperative pyelonephritis had similar stone‐free and ureteroscopy complication rates (97% vs 93%, and 10% vs 12%).
Conclusions
Ureteroscopy after drainage of an obstructed infected kidney can be a safe and effective option, as it seems to not be associated with an increased risk of complications.