王曦賢、張議徽、蕭博任、陳冠亨、吳錫金、黃志平、葉進仲、陳汶吉、鄒頡龍、楊啟瑞、張兆祥中國醫藥大學附設醫院 泌尿部

Hsi-Hsien Wang, Yi-Huei Chang, Po-Jen Hsiao, Guang-Heng Chen, Hsi-Chin Wu, Chi-Ping Huang, Chin-Chung Yeh, Wen-Chi Chen, Chieh-Lung Chou, Chi-Rei Yang, Chao-Hsiang Chang

Department of Urology, China Medical University Hospital, Taichung, Taiwan

 

Purpose: Acute obstructive pyelonephritis is a life-threatening infection, may lead to septic shock, renal damage and multi-organ system failure. The ureter stone is the common cause of urinary tract obstruction. Immediate empiric antibiotic and urinary drainage are the primary treatment, even percutaneous nephrostomy (PCN) tube or ureteral catheter. However, the timing or necessity of PCN insertion is not clear, and there’s no relative literature in our article review. We try to figure out the predictive parameters for evaluation the necessity of PCN tube insertion amount the stones related acute obstructive pyelonephritis patients during initial analysis.

Materials and Methods: We prospectively collect the 75 patients who were diagnosed with stone obstructed acute pyelonephritis from Jan. to Dec. 2016 in our hospital. 13 patients received immediately PCN tube inserting at emergency room and they were not enrolled to our analysis because we want to figure out which factors of acute pyelonephritis patients may lead to uncontrollable or progressed disease that the further PCN tube insertion is necessary. 26 patients (Group 1) received PCN tube insertion later due to persistent spike fever, progressed infection or uncontrollable sepsis; 36 patients (Group 2) had no PCN drainage intervention, received only antibiotic and fluid resuscitation. Definitely treatment for the ureter stone was done after infection under controlled. Patient demographic include age, gender and comorbidities like diabetes mellitus (DM), hypertension (HTN), coronary artery disease (CAD) and cerebrovascular accident (CVA). The disease patterns were stone size, stone location and the severity of hydronephrosis. The initially analyzed data were initial blood WBC count, CRP and creatinine. Analyzed the parameters to predict PCN insertion initially or unnecessary. SPSS 17 is used for statistically method.

Results: There’s statistical significant higher initial WBC in group 1 (p = 0.48) in T test. The stone size also showed significant higher in group 1 (p = 0.002). The age, CRP and creatinine showed no difference. The gender, DM, CAD, CVA, stone location and severity of hydronephrosis showed no difference between the two groups under Chi-square test, but the HTN showed statistical significant (p = 0.014). The initial WBC above 13x10^3/ul and the stone size more than 9.5mm were elective predictive value from ROC curve. The Chi-square test showed statistical significant (p = 0.038), present that the patients with CRP ≥10 had more incidence to receive PCN insertion.

Conclusion: We found that the initial WBC, stone size and CRP ≥10 are potential predictable parameters to decide the necessity of PCN insertion while the initial evaluation of the stones related acute obstructive pyelonephritis patients. We suggest that if the patients have clinical sepsis signs with more than two of these parameters (WBC ≥13x10^3/ul; stone size ≥9.5mm and CRP ≥10), urgent PCN insertion is considered.