(UroToday.com) In the Saturday Plenary session of the 2024 American Urological Association (AUA) Annual Meeting, experts convened to address the intricate challenges surrounding obstructive pyelonephritis due to ureteral stones. Moderated by Dr. Hassan Razvi and Dr. Glenn Preminger, the session featured a comprehensive panel discussion comprising esteemed urologists from around the world.
Dr. Noah Canvasser initiated the discourse by delving into the necessity of drainage in cases of ureteral infection and urinary tract infection. Highlighting the grave consequences of increased intrarenal pressure, which leads to pyelovenous backflow and bacterial translocation, he advocated for immediate drainage, particularly in patients presenting with sepsis. Citing retrospective data, he underscored a significantly lower mortality rate associated with drainage interventions (12% stent and 8% nephrostomy tube) compared to non-drainage cases (40%), emphasizing the critical importance of timely decompression.
Following Dr. Canvasser's insights, Dr. Joseph Crivelli expounded on the optimal drainage modalities, focusing on the comparative efficacy of ureteral stenting versus nephrostomy tube insertion. Despite similar outcomes in preventing fever and leukocytosis reduction between the two methods, Dr. Crivelli emphasized the need for individualized selection based on patient factors such as anticoagulation, anatomical considerations such as bowel urinary diversion, and logistical feasibility such as operating room or interventional radiology availability. Stressing the collaborative effort required among multiple specialties, he underscored the importance of seamless coordination to expedite patient care.
Dr. Jennifer Robles navigated the intricacies of predicting sepsis in patients with obstructive stones, acknowledging the inherent challenges due to heterogeneous outcomes and limited predictive data. While exploring various models and clinical parameters, she underscored the pivotal role of clinical judgment, amalgamating vital signs, laboratory findings, and patient-specific factors in guiding decision-making.
Dr. Alex Meller shed light on strategies to enhance patient outcomes, drawing from studies demonstrating the mortality benefits of early drainage in obstructive pyelonephritis. Emphasizing the significance of interdisciplinary collaboration and timely intervention, he underscored the need for comprehensive pre-decompression assessment and optimization to mitigate the risk of septic shock.
In a succinct summary, Dr. Glenn Preminger encapsulated the imperative of swift action in managing obstructive pyelonephritis, epitomizing the essence of "be quick or be dead." Through a compelling real-world case study, the panel underscored the nuanced decision-making process in selecting appropriate decompression techniques, emphasizing adaptability and swift intervention in the face of unforeseen complications.
As the session drew to a close, Dr. Preminger extended gratitude to the panelists for their invaluable contributions, culminating in a resounding applause from the engaged audience.
The discourse at the 2024 AUA Annual Meeting not only elucidated the complexities of managing obstructive pyelonephritis but also underscored the paramount importance of collaborative, patient-centered care in optimizing clinical outcomes.
Presented by:
- Jennifer Robles · Vanderbilt Urology
- Daron Smith · University College Hospital, London
- Alex Meller · Federal University of Sao Paulo
- Joseph Crivelli · UAB Urology
- Noah Canvasser · University of California Davis
Written by: Bruce Gao MD, FRCSC, Endourology Fellow, Department of Urology, University of California Irvine, @b_gao on Twitter during the 2024 American Urological Association (AUA) Annual Meeting, San Antonio, TX, Fri, May 3 – Mon, May 6, 2024.