Medical Decision-Making for Patients with Urosepsis

Assessment and Management

• Patients with urosepsis may temporarily lack decision-making capacity due to altered mental status from infection, pain and discomfort, and effects of medications 1
• Urgent decompression of the collecting system is required in cases of urosepsis with obstructing stones, and the surrogate must be informed that immediate intervention is necessary to prevent septic complications 1
• The procedure will likely involve placement of a ureteral stent or nephrostomy tube 2
• Definitive stone treatment should be delayed until sepsis is resolved 1

Clinical Management Considerations

• The surrogate should be informed that antimicrobial prophylaxis must be administered prior to stone intervention 3
• If purulent urine is encountered during the procedure, stone removal will be aborted and drainage established 3, 2
• Stone material should be sent for analysis to guide future prevention 3

Documentation Requirements

• The medical record should clearly document any discussions regarding treatment options and risks/benefits 2