Presentation Authors: Vigen Malkhasyan*, George Kasyan, Malika Dzhuraeva, Igor Semenyakin, Dmitriy Pushkar, Vadim Ivanov, Moscow, Russian Federation
Introduction: Emergency drainage of the upper urinary tract may be undertaken by either the placement of an internal ureteric stent or percutaneous nephrostomy and is a standard treatment procedure for patients with acute obstructive pyelonephritis. Few randomized, published studies showed equal efficacy for both methods among patients with obstructive urolithiasis and signs of upper urinary tract infection, but these studies did not include patients' treatment preferences. To date, there have been no clear guidelines for the selection of an optimal treatment plan for upper urinary tract obstruction in obstructive pyelonephritis. In this study, we sought to identify the best method for draining the upper urinary tract in obstructive pyelonephritis.
Methods: A prospective analysis of the patients with acute obstructive pyelonephritis treated in our clinic from 2015 to 2016 was performed. Patients needing drainage of the UUT and having no contraindications for percutaneous nephrostomy or ureteric stenting were included in the analysis. In this study, patients have been provided with detailed information regarding the methods of drainage and possible complications of each procedure. Afterward, the patients were asked to fill out a special questionnaire.
Results: The total cohort consisted of 209 patients, and the median age of patients was 45. Females comprised 45% of the cohort. Most of the patients (89%) in the cohort suffered from urolithiasis. A total of 57.2% of patients reported not being competent to choose a particular drainage method; therefore, they relied on their doctors while making decisions regarding treatment options. _x000D_
A total of 96.5% of patients decided to undergo ureteric stenting, and 70.6% of patients regarded stenting as an attractive alternative to percutaneous nephrostomy. Only 3.5% of patients preferred nephrostomy. Most of the patients (66%) considered that a ureteric stent would allow for preservation of their quality of life standards, and only 16.9% of patients thought that a stent would lead to marked pain and discomfort. A total of 61% of patients called placement of a ureteric stent an intervention they would like to avoid. The overwhelming majority of patients (87%) negatively viewed nephrostomy, as they considered this method would lead to a massive quality of life reduction. Only 1.5% of patients stated that nephrostomy would allow them a good quality of life. _x000D_
A total of 12% of patients were concerned that nephrostomy would lead to marked pain and discomfort. A total of 77% of patients called percutaneous nephrostomy an intervention that they would like to avoid.
Conclusions: Patients hospitalized with acute obstructive pyelonephritis are not sufficiently informed about and do not have an adequate understanding of the advantages and disadvantages of their respective treatment options, which is why they are not able to self-sufficiently choose the treatment modality. As a result, 57.2% of patients delegated decision-making to their consultant doctor. Regarding the rest, out of 86 patients, 83 decided to undergo a ureteric stent placement, and only 3 out of 86 patients agreed to percutaneous nephrostomy.