SAN FRANCISCO, CA USA (UroToday.com) - Surgical intervention for patients with obstructing stone disease is generally accepted for those presenting with fever and unrelenting pain. However, the decision to offer a trial of medical management or spontaneous passage is less clear in patients who are afebrile. Researchers at Chapel Hill in North Carolina examined laboratory cut-off points for intervening in afebrile patients with acute stone disease. The study included 414 patients with urine culture results who had presented with renal stone disease and were afebrile between January 2005 and January 2009. They assessed WBC and absolute neutrophil count (ANC) obtained, when available within 14 days before stent placement.
From their analysis, they found that a WBC cutoff point of 15x109/L correctly classified 78% of subsequent positive urine cultures and a cutoff of 19x109/L correctly classified 84% of the positive culture patients. In addition, for the ANC, a cutoff point of 15x109/L and 19x109/L correctly classified 80% and 85% respectively, of patients with a positive urine culture. The correlation coefficients for WBC and positive culture, and ANC and positive culture were 0.15 and 0.25, respectively.
Therefore, WBC and ANC cutoffs can be used clinically to predict infection in afebrile patients with acute stone disease as high WBC and ANC cutoff predict a high percentage of positive cultures. This information can help the clinician identify patients who should be offered surgical intervention as opposed to medical management and observation for their acute stone disease.
Presented by David C. Johnson, Angela M. Smith, Raj S. Pruthi, Culley C. Carson, Matthew E. Nielsen, and Eric M. Wallen at the American Urological Association (AUA) Annual Meeting - May 29 - June 3, 2010 - Moscone Center, San Francisco, CA USA
Reported for UroToday by Phillip Mucksavage, MD, Staff Urologist, University of California, Irvine, CA.
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