MP68-08 EARLY URETEROSCOPIC TREATMENT IS AS SAFE AS DEFERRED TREATMENT IN PATIENTS WITH UROSEPSIS ASSOCIATED WITH URETERAL CALCULI. A PROSPECTIVE, RANDOMIZED CLINICAL TRIAL

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy IV1 Apr 2018MP68-08 EARLY URETEROSCOPIC TREATMENT IS AS SAFE AS DEFERRED TREATMENT IN PATIENTS WITH UROSEPSIS ASSOCIATED WITH URETERAL CALCULI. A PROSPECTIVE, RANDOMIZED CLINICAL TRIAL Gaston Astroza, Miguel Sarras, Alejandro Majerson, Jose Salvado, and Javier Dominguez Gaston AstrozaGaston Astroza More articles by this author , Miguel SarrasMiguel Sarras More articles by this author , Alejandro MajersonAlejandro Majerson More articles by this author , Jose SalvadoJose Salvado More articles by this author , and Javier DominguezJavier Dominguez More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2212AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Obstructive ureteral calculi are a common cause of urosepsis. Emergent drainage of the urinary tract is the first necessary approach. Appropriate waiting time before definitive treatment has not been determined. We hypothesized that an early ureteroscopic treatment is as safe as deferred treatment. METHODS After approval of ethics committee, a prospective randomized clinical trial was developed in our institution between November 2013 and September 2017. Only patients admitted with urosepsis associated with ureteral calculi were considered to participate. Urosepsis was defined as at least 2 systemic inflammatory response syndrome criteria plus an urine or blood positive culture. All the patients were initially decompressed with a ureteral stent. Patients who accepted to participate were randomized to early ureteroscopic treatment (EG) (48 to 72 hours without fever) or deferred treatment (DG) (at least 7 days after discharge). APACHE II score was calculated in all of them. Complications after the ureteroscopy (URS) were registered (fever, sepsis, ureteral injury, others). Total length of stay, antibiotic treatment, length of ureteral stent and complication rate were compared. Statistical analysis was performed using Stata 12.0. RESULTS A total of 27 patients were randomized. A patient in deferred group left the protocol. Finally, 13 were included in EG and 13 in DG. Mean age was 43 years in DG and 49 years in EG. Mean stone size was 6 millimeters (mm) in DG and 7 mm in EG. No differences in gender distribution, side of ureteral calculi, stone location, APACHE II score, age, stone size and time between admission and urinary drainage were founded. Total length of stay, duration of antibiotics or complications were also similar between both groups. A statistically significant difference was found in terms of time between drainage and definitive stone management (p= 0.00) and total number of days with ureteral catheter (p= 0.012). 3 patients presented complications. Only 1 patient in EG developed fever post URS CONCLUSIONS Early ureteroscopic management for ureteral stone is as safe as deferred treatment in patients admitted with urosepsis. Early treatment is associated with a shorter period of ureteral stent © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e919 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Gaston Astroza More articles by this author Miguel Sarras More articles by this author Alejandro Majerson More articles by this author Jose Salvado More articles by this author Javier Dominguez More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...