Evidence-based drainage of infected hydronephrosis secondary to ureteric calculi.

INTRODUCTION: The obstructed, infected kidney is a urological emergency. It has been accepted that the management of infected hydronephrosis secondary to ureteric stones is through prompt decompression of the collecting system. However, the optimal method of decompression has yet to be established. MATERIALS AND METHODS: A PubMed and Medline search was performed of all English-language articles from 1960 using key words "sepsis," "urosepsis," "obstruction," "obstructive pyelonephritis," "pyonephrosis," "infection and hydronephrosis" "decompression," "stent," "nephrostomy," and "management." The Cochrane database and National Institute for Clinical Effectiveness guidelines were searched using the terms "sepsis," "urosepsis," "stent," "nephrostomy," or "obstruction." Scottish intercollegiate guidelines were reviewed and no relevant guidance was identified. RESULTS: Two randomised trials have compared retrograde stent insertion with percutaneous nephrostomy with one trial reporting specifically on patients with acute sepsis and obstruction. Neither trial showed one superior modality of decompression in effecting decompression and resolution of sepsis. A further literature search regarding the complications of percutaneous nephrostomy and stent insertion was carried out. An overall major complication rate from percutaneous nephrostomy insertion was found to be 4%, although the complication rates from stent insertion are less consistently reported. DISCUSSION: There appears little evidence to suggest that retrograde stent insertion leads to increased bacteraemia or is significantly more hazardous in the setting of acute obstruction. Further region-wide discussion between urologists and interventional radiologists is required to establish management protocols for these acutely unwell patients.

The development and audit of a nurse-led urology/oncology clinic.

People with cancer in the UK should have access to a full spectrum of services. The role of the clinical nurse specialist is an important part of this development. In the specialty of urology/oncology, this role is still a relatively new development although the incidence of urological malignancy readily compares with other site-specific cancers.