Emergency percutaneous nephrostomy versus emergency percutaneous nephrolithotomy in patients with sepsis associated with large uretero-pelvic junction stone impaction: a randomized controlled trial

Vol. 43 (3): 481-488, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2015.0643


ORIGINAL ARTICLE

Chi-Sen Hsu 1, Chung-Jing Wang 2, Chien-Hsing Chang 2, Po-Chao Tsai 2, Hung-Wen Chen 3, Yi- Chun Su 3
1 Department of Infection, Saint Martin De Porres Hospital, Chiayi, Taiwan, R.O.C.; 2 Division of Urology, Department of Surgery, Saint Martin De Porres Hospital, Chiayi, Taiwan, R.O.C.; 3 Department of Emergency, Saint Martin De Porres Hospital, Chiayi, Taiwan, R.O.C.

ABSTRACT

Introduction: A randomized trial was conducted prospectively to evaluate the efficacy, related complications, and convalescence of emergency percutaneous nephrolithotomy compared to percutaneous nephrostomy for decompression of the collecting system in cases of sepsis associated with large uretero-pelvic junction stone impaction.

Materials and Methods: The inclusion criteria included a WBC count of 10.000/mm3 or more and/or a temperature of 38°C or higher. Besides, all enrolled patients should maintain stable hemodynamic status and proper organ perfusions. A total of 113 pa­tients with large, obstructive uretero-pelvic junction stones and clinical signs of sepsis completed the study protocol. Of those, 56 patients were placed in the emergency per­cutaneous nephrostomy group, while the other 57 patients were part of the percutane­ous nephrolithotomy group. The primary end point was the time until normalization of white blood cells (WBC) at a count of 10.000/mm3 or less, and a temperature of 37.4°C or lower. The secondary end points included the comparison of 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 were used as appropriate.

Results: The length of hospital stays (in days) was 10.09±3.43 for the emergency per­cutaneous nephrostomy group and 8.18±2.72 for the percutaneous nephrolithotomy group. This set of data noted a significant difference between groups. There was no difference between groups in regard to white blood cell count (in mm3), time to nor­malization of white blood cell count (in days), body temperature (in ºC), time to nor­malization of body temperature (in days), C-reactive proteins (in mg/dL), time taken for C-reactive proteins to decrease over 25% (in days), procalcitonin (in ng/mL), or complication rates.

Conclusions: This study confirms that emergency percutaneous nephrolithotomy may be as safe as early percutaneous nephrolithotomy in a selected low risk patients with sepsis-associated large, obstructive stone.

Keywords: Sepsis; Nephrostomy, Percutaneous; complications [Subheading]

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