Evidence-based drainage of infected hydronephrosis secondary to ureteric calculi.
J Endourol
; 24(2): 185-9, 2010 Feb.
Article
em En
| MEDLINE
| ID: mdl-20063999
ABSTRACT
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 ANDMETHODS:
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.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Cálculos Ureterais
/
Drenagem
/
Medicina Baseada em Evidências
/
Pionefrose
Tipo de estudo:
Clinical_trials
/
Guideline
/
Qualitative_research
/
Systematic_reviews
Limite:
Humans
Idioma:
En
Ano de publicação:
2010
Tipo de documento:
Article