SAN DIEGO, CA USA (UroToday.com) - Urolithiasis represents a significant burden on health care in the United States, and worldwide.
The rising prevalence of urolithiasis in the United States has been linked to increasing rates of obesity, diabetes, and metabolic syndrome. Untreated upper urinary tract calculi may result in obstruction and infection. Occasionally, infection in the obstructed urinary tract poses an imminent threat to the patient and may induce significant morbidity. The treatment of infected and obstructive urolithiasis involves prompt decompression of the renal collecting system, either by retrograde ureteral stenting (RUS) or percutaneous nephrostomy (PCN). The incidence of infected urolithiasis is unknown, and evidence describing the optimal management strategy for obstruction is equivocal. The group from the Vatikutti Institute assessed utilization trends in the incidence of RUS and PCN, as well as the distribution of practice patterns of these competing treatment modalities. Additionally, they assessed adverse outcomes related to each intervention strategy.
In their evaluation they used a weighted estimate of 396 385 adult patients, hospitalized with infected urolithiasis, extracted from the Nationwide Inpatient Sample from 1999 to 2009. Temporal trends in rates of RUS and PCN for urgent/emergent decompression were quantified, and propensity score matching was used to compare the rates of adverse outcomes between approaches.
The results of their study demonstrated that in patients undergoing immediate decompression for infected urolithiasis, PCN utilization significantly decreased from 16% to 11% over the study period. There was significant variability in utilization trends between regions. Overall, PCN showed higher rates of sepsis, severe sepsis, prolonged length of stay, elevated hospital charges and mortality.
In conclusion, this study demonstrated decreasing rates of PCN utilization for immediate decompression of infected urolithiasis. Compared to RUS, PCN was associated with higher rates of adverse events. However, the findings from this observational study should be interpreted considering the limitations of the study. This includes the risk for confounding by indication, with the patients in the PCN group receiving PCN over RUS because they had worse infection and more comorbidities.
Presented by Khurshid Ghani, MD at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA
Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
Reported for UroToday.com by Zhamshid Okhunov, MD and Michael Ordon, MD; UC Irvine Medical Center, Orange, CA USA
