📃 Paper Title: Optimal method of urgent decompression of the collecting system for obstruction and infection due to ureteral calculi
🧍 Author: Pearle
🕒 Year: 1998
📚 Journal: Journal of Urology
🌎 Country: USA
ㅤContext to the study:
Can you tell me about an RCT that evaluated the efficacy of percuteneous nephrostomy vs retrogrde urethral cathetherisation for an obstructed and infected kidney?
ㅤ✅ Take-home message of study:
This randomised controlled trial of percutaneous nephrostomy vs retrograde ureteral catheterisation for the infected obstructed kidney showed no difference in time to resolution of fever and normalisation of white cell count between groups. Percutaneous nephrostomy was less expensive, but associated with higher levels of reported back pain.
ㅤ Randomised controlled trial of percutaneous nephrostomy v retrograde ureteral catheterisation
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Study participants:
Study size and inclusion criteria:
42 consecutive patients presenting to the emergency department with an obstructing ureteric calculus and clinical signs of infection (defined as fever >38 degrees or white cell count > 17,000).
Exclusion criteria:
Patients in whom either form of decompression were contraindicated were excluded.
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Key study outcomes:
Primary outcome:
There was no difference in the time to normalisation of temperature (< /=37.4) degrees and/or white cell count (< /=10,000) between the groups (2.6 v 2.4 days respectively 'p = not significant')
Secondary outcomes:
Tolerance - Back pain was perceived to be greater in the percutaneous nephrostomy group (37.2 v 6.5 on a scale of 0 to 100, p<0.05).
Cost - percutaneous nephrostomy cost less than retrograde ureteral catheterisation ($1,137.01 v $2,401.33).
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Study Limitations:
Seven patients were included without fever on the basis of a presentation with a white cell count >/=17000, which was an arbitrarily selected cut off. The primary outcome including normalisation of white cell count < /=10000 is not clinically meaningful. Leukocytosis is common in obstructing ureteric calculi, and not necessarily a sign of an infected system. It is not clear how the study population might differ in a modern clinical scoring system for sepsis e.g. SIRS or qSOFA had formed the basis for eligibility. The sample size was not powered to detect a difference in secondary outcomes.
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