Management of Urosepsis with Vesical Calculus

Initial Management of Urosepsis

The American Urological Association recommends obtaining urine and blood cultures before initiating antibiotics, but does not delay antibiotic administration while awaiting results 1
Immediate broad-spectrum antibiotic therapy should be initiated, with third-generation cephalosporins showing superior outcomes compared to fluoroquinolones 1
Urgent decompression of the collecting system is mandatory as the compromised delivery of antibiotics into the obstructed kidney requires drainage to promote resolution of infection 1, 2
The choice between percutaneous drainage or ureteral stenting is at the discretion of the urologist, as both have been shown to be equally effective in the setting of obstructive pyelonephritis/pyonephrosis 2, 3
DJ stenting has been shown to be safe and effective in patients with sepsis and obstructing calculi, with decreased duration of hospital stay and ICU admission rates compared to percutaneous nephrostomy in some cases 3

Definitive treatment of the stone should be delayed until sepsis is resolved and the infection is cleared following a complete course of appropriate antimicrobial therapy 1, 2

Complete removal of the stone is essential to eradicate causative organisms, relieve obstruction, prevent further stone growth, and eliminate the source of infection 1
Follow-up imaging to confirm complete stone removal is essential after definitive treatment 1

Patients should be followed with periodic imaging studies to monitor stone position and to assess for hydronephrosis 4
For septic patients, monitoring of organ function using either the full SOFA or qSOFA score is recommended 5
Early imaging investigations, including sonography and computed tomography scans, should be conducted to identify any complications 5

Blind basketing (stone extraction without endoscopic visualization) should never be performed due to risk of ureteral injury 6
Collaborative treatment involving urologists, intensive care, and infectious disease specialists is recommended for optimal patient care 5

Patient survival was significantly higher (92%) when decompression was used compared to medical therapy alone without decompression (60%) 1