MP29-11 NEPHROSTOMY TUBE VS. URETERAL STENT FOR OBSTRUCTING SEPTIC CALCULI: A NATIONWIDE PROPENSITY SCORE MATCHED ANALYSIS

Abstract

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder II (MP29)1 Sep 2021MP29-11 NEPHROSTOMY TUBE VS. URETERAL STENT FOR OBSTRUCTING SEPTIC CALCULI: A NATIONWIDE PROPENSITY SCORE MATCHED ANALYSIS Rachel Wong, Sylvain Lother, Premal Patel, and Barret Rush Rachel WongRachel Wong More articles by this author , Sylvain LotherSylvain Lother More articles by this author , Premal PatelPremal Patel More articles by this author , and Barret RushBarret Rush More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002026.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Sepsis secondary to obstructive uropathy is a Urological emergency associated with significant mortality and morbidity. Urgent decompression using retrograde placement of a ureteric stent (US) or a percutaneous nephrostomy tube (PCN) remains the gold standard of treatment in conjunction with fluid resuscitation and IV antibiotics. Prior literature suggests that advantages to PCN include higher insertion success rate as well as a shorter procedural time, which may account for the benefit in mortality. However, scant data exists regarding the optimal method for decompression. METHODS: Utilizing the National Inpatient Sample (NIS) database from 2006-2014 we created a cohort of patients ≥18 years of age with a diagnosis of sepsis and a ureteral/renal calculi that underwent US or PCN. A multivariate logistic regression model predicting in-hospital mortality was created incorporating the 29 Elixhauser comorbidities, hemodialysis, shock, and mechanical ventilation. Additionally, a propensity score matched cohort was created based on the propensity to receive each treatment. RESULTS: Of these, 9,828 (28.9%) patients underwent ureteral stenting and 24,181 (71.1%) underwent PCN. The unadjusted mortality rate for US patients was 2.8% compared to 5.3% in the PCN group (p <0.01). Patients who received US were more likely to be female (61.7% vs 53.8%, p <0.01), White (69.3% vs 64.5%, p <0.01), and have private health insurance coverage (26.5% vs 20.9%, p <0.01, Table 1). After adjustment for baseline characteristics, having a US compared to PCN was associated with a lower risk of mortality (OR 0.72, 95% CI 0.63-0.83, p <0.01) After matching patients based on propensity score, the mortality rate for patients who received a US was 3.5% compared to 3.9% in the PCN group (p=0.26). CONCLUSIONS: This large national analysis demonstrates that US placement in septic obstructive uropathy is associated with lower mortality compared to PCN. After propensity score matching this finding was no longer statistically significant. Further prospective randomized trials are needed to address this important clinical question. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e493-e494 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rachel Wong More articles by this author Sylvain Lother More articles by this author Premal Patel More articles by this author Barret Rush More articles by this author Expand All Advertisement Loading ...