在上段輸尿管結石併尿路敗血症患者中放置經皮腎造廔管的理想時機

徐任廷¹、鐘旭東¹、鄭百諭¹

¹亞東紀念醫院 外科部 泌尿科

Optimal Timing of Percutaneous Nephrostomy (PCN) in Patients with Upper Ureteral Stones and Urosepsis

Jen-Ting Hsu¹ , Shiu-Dong Chung¹, Pai-Yu Cheng,¹

Division of Urology¹ Department of Surgery, Far Eastern Memorial Hospital, New Taipei City

Purpose: Urosepsis is a life-threatening condition often induced by acute stone-related urinary obstruction. Treatment includes broad-spectrum antibiotics and decompression via percutaneous nephrostomy (PCN), with ureteroscopic lithotripsy (URSL) performed once infection stabilizes. Our study examines the impact of different PCN placement timings on the prognosis of urosepsis caused by upper ureteral stones..

Materials & Methods

From 2013 to 2019, 107 patients with upper ureteral stones complicated by urosepsis and fever (≥37.5°C) were analyzed. Patients were grouped by PCN timing: within 24 hours or after 24 hours. Empirical antibiotic choice and treatment duration before URSL were based on the physician’s judgment and clinical conditions. Groups were compared by age, gender, stone location, max stone length, urine and blood cultures, post-URSL fever, hospitalization duration, and time from admission to URSL.

Results

Demographic characteristics, including age, gender, stone location, and maximum stone length, were similar between groups, as were post-URSL fever rates. The average delay in PCN placement over 24 hours was 3.4 days. The immediate PCN group can receive URSL sooner (6 vs. 8.2 days, p<0.001) and have shorter hospital stays (9.6 vs. 12.1 days, p=0.007).

Conclusions

For patients with urosepsis due to upper ureteral stones, early PCN placement facilitates earlier URSL and shortens hospital stays