Optimal Timing of Percutaneous Nephrostomy Tube Drainage of Infected Kidneys Secondary to Obstructing Ureteral Stones

Obstructing ureteral stones with urinary tract infection (UTI) represent a urological emergency requiring prompt decompression to prevent sepsis-related morbidity and mortality. Although percutaneous nephrostomy (PCN) is a widely used drainage method, the optimal timing for its insertion remains unclear. This study explored the association between the timing of PCN insertion and clinical outcomes.

A retrospective review of 744 patients who underwent PCN insertion for ureteral stones and UTI between 2011 and 2023. Patients were grouped by time-to-drainage from emergency department arrival: Immediate (<6 hours, n = 241), early (6-24 hours, n = 232), and delayed (>24 hours, n = 271). Infectious status was assessed at presentation, before, and after PCN insertion. Primary outcomes were sepsis, septic shock, and intensive care unit (ICU) admission rates. Multivariable analysis identified predictors of non-immediate drainage.

In the immediate drainage group, sepsis rate decreased following PCN insertion (61.4% pre-PCN vs 45.2% post-PCN, p = 0.03), whereas septic-shock rates remained unchanged (23.7% vs 23.2%, p = 0.6). In the early drainage group, sepsis remained unchanged (59.1% vs 59.5%, p = 0.11) after PCN insertion, whereas septic shock increased (12.9% vs 31%, p < 0.001). A similar pattern was observed in the delayed group, with unchanged sepsis (38.7% vs 36.9%, p = 0.14) but increased septic shock rates (7% vs.15.5%, p = 0.001) following PCN insertion. Immediate drainage was associated with shorter hospitalization, fewer ICU admissions, and earlier stone treatment (all p < 0.001). Predictors of non-immediate drainage included night-shift arrival (odds ratio [OR]: 4.846, p < 0.001), female gender (OR: 1.917, p = 0.002), elevated creatinine (OR: 1.262, p = 0.011), and older age (OR: 1.009, p = 0.018).

Decompression with PCN within 6 hours is associated with significantly improved infectious and clinical outcomes in patients with obstructed, infected kidneys caused by ureteral stones.