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Beitragstitel Is conservative management safe in carefully selected patients with obstructive ureterolithiasis and perirenal stranding or fornix rupture?
Beitragscode P034
Autor:innen
  1. Nico Christian Grossmann Universitätsspital Zürich Präsentierende:r
  2. Benedikt Kranzbühler Universitätsspital Zürich
  3. Jeannine Betschart Universitätsspital Zürich
  4. Anton Becker Universitätsspital Zürich
  5. Thomas Hermanns Universitätsspital Zürich
  6. Daniel Eberli Universitätsspital Zürich
  7. Tullio Sulser Zentrum für Urologie Zürich - Klinik Hirslanden
  8. Etienne Xavier Keller Universitätsspital Zürich
  9. Christian Daniel Fankhauser Universitätsspital Zürich
Präsentationsform Freie Mitteilungen
Themengebiete
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Abstract-Text Introduction:
Perirenal stranding (PS) and signs of fornix rupture (FR) can be observed in computerized tomography (CT) scans of patients (pts) with ureterolithiasis. There is scarce evidence whether the urinary tract of pts with PS and/or FR needs to be decompressed and/or treated with empiric antibiotics.

Methods:
We retrospectively identified pts diagnosed with ureterolithiasis on CT scans between 2011 and 2017. Characteristics of patients with PS and/or FR treated either by conservative management (CM) or interventional management (IM) were compared.

Results:
Of 708 pts with ureterolithiasis, PS and FR was reported in 188 (27%) and 27 (4%) pts respectively. Of 188 pts with PS, 114 pts were treated with CM, and 74 pts with IM. Pts with CM versus IM were different for the following variables: median age (54 vs 47 years), median stone size (4 vs 7mm), stone location, median body temperature (36.6 vs. 37.5 °C), median CRP (1.5 vs 8.5), median leukocytosis (10 vs 11), median leukocyturia (20 vs 31) (all p < 0.0.5) but not for gender (11 vs 18% female), bacteriuria (42 vs 46%) or nitrate positive urine (1 vs 2%). In pts treated with CM spontaneous stone passage was observed in 110/114 (97%) pts and after a median of 5 (IQR 2-10) days. Stent insertion and secondary URS was required in 3/114 (3%) pts and 1/114 (1%) patient developed a urinary tract infection with subsequent sepsis.
Of 27 pts with FR, 13 pts were treated with CM and 14 with IM. Pts with CM versus IM had a higher median body temperature (36.5 vs. 36.8 °C) but did not differ significantly regarding median age (49 vs 49 years), gender (31 vs 21% female), median stone size (5 vs 6mm), stone location, median leukocytosis (11 vs 11), median CRP (1.4 vs 2.7), bacteriuria (42 vs 46%) or nitrate positive urine (1 vs 2%). In pts treated with CM hospital admission was necessary in 4/13 (31%), empiric antibiotic therapy was given in 2/13 (15%) with no urine culture turning out positive. Spontaneous stone passage was observed in all pts after a median of 4 (IQR 3-4) days and no readmissions or complications were observed.

Conclusions:
CM is an option in carefully selected, well-informed and compliant pts with PS or FR because of ureterolithiasis. However, a prospective validation whether CM can be offered in patients with PS or FR without risk factors for infections is required.