Pd19-06 ureteral stent decompression is associated with decreased length of stay in obstructive, infected ureteral stones: a multicenter, retrospective case control study

You have accessJournal of UrologyCME1 May 2022PD19-06 URETERAL STENT DECOMPRESSION IS ASSOCIATED WITH DECREASED LENGTH OF STAY IN OBSTRUCTIVE, INFECTED URETERAL STONES: A MULTICENTER, RETROSPECTIVE CASE CONTROL STUDY Albert S. Ha, Gregory W. Hruby, David S. Han, Rainjade Chung, Jeffrey Johnson, Isaac H. Michaels, Aaron Brant, Christina Sze, Annanias Motta Burgos, Spyridon Basourakos, Patrick Lewicki, Timothy McClure, and Ojas Shah Albert S. HaAlbert S. Ha More articles by this author , Gregory W. HrubyGregory W. Hruby More articles by this author , David S. HanDavid S. Han More articles by this author , Rainjade ChungRainjade Chung More articles by this author , Jeffrey JohnsonJeffrey Johnson More articles by this author , Isaac H. MichaelsIsaac H. Michaels More articles by this author , Aaron BrantAaron Brant More articles by this author , Christina SzeChristina Sze More articles by this author , Annanias Motta BurgosAnnanias Motta Burgos More articles by this author , Spyridon BasourakosSpyridon Basourakos More articles by this author , Patrick LewickiPatrick Lewicki More articles by this author , Timothy McClureTimothy McClure More articles by this author , and Ojas ShahOjas Shah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002557.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Obstructive, infected ureteral stones are urologic emergencies requiring prompt decompression. Few studies with adequate power and granular data to compare decompression via ureteral stent vs. nephrostomy tube currently exist. As such, the understanding of the comparative efficacy of these two procedures remains ambiguous. METHODS: Using the New York Presbyterian enterprise data warehouse (2012-2020) from two large, urban academic centers, we identified 1,936 patients with an Emergency Department (ED) visit for an obstructive ureteral stone. 524 patients with documented positive urine cultures and ureteral decompression via stent or nephrostomy tube (PCN) were subsequently analyzed [Figure 1A]. To reduce selection bias, a random sample of 100 intensive care unit (ICU), 150 positive blood culture, and 200 length of hospital stay (LOS) ≥4 days cases and 200 corresponding controls were selected for respective outcomes. Backwards stepwise logistic regression was performed and known confounders were subsequently added to construct multivariable models of best fit. RESULTS: On multivariate analysis, ureteral stent decompression was associated with LOS <4 days (OR: 0.37; p<0.001) and decreased odds of positive blood cultures (OR: 0.51; p=0.021) but not ICU utilization (OR: 0.63; p = 0.16) when compared to PCN [Figure 1B]. Increased time to decompression was associated with increased LOS (OR: 1.03; p<0.001), and greater Charlson Comorbidity Index (CCI) was associated with ICU utilization (OR 1.09; p = 0.040). Positive sepsis criteria were associated with increased odds of ICU utilization (OR: 4.32; p<0.001) and positive blood cultures (OR: 2.67; p<0.001). CONCLUSIONS: Sepsis criteria, prolonged time to decompression, and CCI were associated with worse outcomes in patients with obstructive, infected ureteral calculi. While stent placement was associated with reduced likelihood of positive cultures, we hypothesize that underlying surgical selection on part of the urologist may be involved. Further investigation of the underlying methodologies of management is warranted. Most importantly, despite controlling for multiple factors, stent utilization was associated with reduced length of stay. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e351 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Albert S. Ha More articles by this author Gregory W. Hruby More articles by this author David S. Han More articles by this author Rainjade Chung More articles by this author Jeffrey Johnson More articles by this author Isaac H. Michaels More articles by this author Aaron Brant More articles by this author Christina Sze More articles by this author Annanias Motta Burgos More articles by this author Spyridon Basourakos More articles by this author Patrick Lewicki More articles by this author Timothy McClure More articles by this author Ojas Shah More articles by this author Expand All Advertisement PDF downloadLoading ...