Accelerated Stone Treatment Following Stenting For Complicated Nephrolithiasis

From the 2018 HVPAA National Conference

Preston Kerr (UTMB), Megan Swonke (UTMB), Ali Mohammad (UTMB), Tamer Dafashy (UTMB), Christopher Kosarek (UTMB), Joseph Sonstein (UTMB)

Background

The accepted management of infected ureteral stones includes emergent decompression of the collecting system as well as antibiotic therapy. When treating infected (struvite) stones, it is important to keep the urine free of bacteria after removal in order to prevent further infection. Antibiotics may be prescribed and regular urinalyses performed. Read the full article here: antibioticstore.online Despite this, there is no consensus guidelines suggesting the optimal time to undergo definitive stone management following emergent decompression.

Objectives

We sought to elucidate an accelerated timeline and approach to treating a septic kidney stone.

Methods

We retrospectively reviewed four cases in which patients had clinical signs and symptoms of sepsis, and an obstructive ureteral stone. Patients underwent emergent decompression with double J ureteral stents, and based on labs and clinical improvement, patients were subsequently treated via ureteroscopy with laser lithotripsy (URS-LL) within 5 days of decompression and initiation of antibiotics. The timing of URS-LL, the length of hospital stay, and postoperative complications were documented

Results

All patients presented received URS-LL within 5 days of decompression and antibiotics. There were no sepsis related postoperative complications from the accelerated course of treatment, resulting in discharge within 2 days following definitive therapy. Appropriate oral antibiotic therapy was continued postoperatively, and stents were removed within three weeks.

Conclusion

Upon analyzing these four cases at our institution, we did not observe any significant adverse outcomes related to sepsis in treating patients within 5 days of decompression when compared to the more conservative approach of withholding treatment for 1 to 2 weeks. This ultimately questions the prior “dogma” that definitive treatment of such stones should follow a prolonged course of antibiotics.

Implications for the Patient

The commonly prescribed 2 week antibiotic regimens prior to the definitive treatment of an infected is unnecessary and can be shortened to five days. This may decrease antibiotic related complications as well as a significant cost savings while generating excellent outcomes

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