Emergency drainage for urosepsis associated with upper urinary tract calculi

We examined the characteristics of patients with urosepsis associated with upper urinary tract calculi requiring emergency drainage.

From January 1994 to December 2003, 424 patients were admitted to our urological department a total of 473 times for treatment of upper urinary tract calculi, of whom 53 required a total of 59 emergency drainage procedures for urosepsis. We summarized the characteristics of these patients and events, and determined risk factors for emergency drainage using logistic regression analysis.

In 14 events (24%) intensive management, such as the use of vasopressors and anticoagulants, was performed. Transient thrombocytopenia less than 100,000/mm occurred in 18 events (31%). Hyperbilirubinemia occurred in 8 of 38 events (16%) without prior antibiotic therapy. One patient (2%) died of urosepsis. Patients with calculi who underwent emergency drainage required a longer hospital stay than those without emergency drainage (25.2 vs 14.8 days, p <0.001). Of the variables analyzed poor performance status (Karnofsky performance status 70% or less, OR 2.9, p = 0.003), age 75 years or older (OR 2.1, p = 0.038) and female sex (OR 1.8, p = 0.046) were risk factors on multivariate analysis.

Our findings suggest that the frequency of emergency drainage in elderly patients with poor performance status has increased in recent years, at least in our rural area of Japan. Preventing calculous formation and urinary tract infection in individuals with poor performance status will be of considerable importance in the future.