Impact of the Timing of Ureteral Stent Placement on Outcomes in Patients with Obstructing Ureteral Calculi and Presumed Infection.

Abstract

Objective: To understand how time to stent placement impacts outcomes in patients with obstructing ureteral stones and concern for infection. Materials and Methods: Using a prospective urology consult institutional database (2011-2016), we identified patients who presented to the emergency department (ED) with an obstructing ureteral stone, met two or more systemic inflammatory response syndrome (SIRS) criteria (temperature [T] >38°C or <36°C, heart rate >90 beats per minute, respiratory rate >20 breaths per minute, white blood cell count >12 k/μL or <4 k/μ), and underwent stent placement. The primary outcome of interest was impact of stent timing on intensity of care (need for intensive care unit [ICU]) as well as overall length of stay (LOS). Results: Forty-eight patients were identified who met the study criteria. Overall, 58.3% had positive urine cultures. There was no difference between groups with across a range of clinical variables. While the need for ICU admission did not differ between groups, those patients who had a ureteral stent placed within 6 and 10 hours of ED arrival had a significantly decreased LOS (35.6 hours vs 71.6 hours, p = 0.01; 45.7 hours vs 82.4 hours, p = 0.04) relative to those patients who were stented outside these intervals. Conclusion: In patients with an obstructing ureteral calculus and concern for infection, there is a beneficial effect to timelier stent placement in the form of decreased overall LOS.