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Background <p>Septic obstructing ureteral stones are a time-critical urological emergency. Although urgent drainage is recommended, uncertainty persists regarding the comparative effectiveness of decompression strategies and the influence of timing in real-world practice.</p> Methods <p>We analyzed adults with sepsis or septic shock and obstructing ureteral stones (<i>n</i> = 9,172) from the U.S. HCUP National Inpatient Sample (2016–2022). Exposures included any decompression (ureteral stent or percutaneous nephrostomy [PCN]) versus conservative care, and decompression timing (same-day [day 0] vs. ≥ day 1; ≤ 24&#xa0;h vs. &gt; 24&#xa0;h). The primary outcome was in-hospital mortality; secondary outcomes were acute kidney injury (AKI), mechanical ventilation, dialysis, and length of stay. Adjusted associations were estimated using propensity score matching, overlap weighting, instrumental variable (IV) analysis, and landmark/time-dependent survival models with a prespecified 12-variable adjustment set.</p> Results <p>Overall mortality was 2.5%. Decompression was associated with lower mortality than conservative care (1.6% vs. 4.0%; risk difference − 2.4% [95% CI − 3.2 to − 1.7]; number needed to treat ≈ 41). Late decompression (&gt; 24&#xa0;h) versus early (≤ 24&#xa0;h) was associated with higher odds of mortality (OR 2.17 [1.38–3.41]), AKI, ventilation, and dialysis. In exploratory analyses among decompressed patients, PCN showed higher adjusted mortality than stenting (5.5% vs. 2.8%; OR 2.05 [1.31–3.09]); IV results were directionally consistent but likely reflect residual confounding by indication and feasibility.</p> Conclusion <p>Urgent decompression, particularly within 24&#xa0;h, was associated with lower in-hospital mortality and fewer organ-failure outcomes. Modality differences should be interpreted as hypothesis-generating; PCN remains essential when retrograde stenting is not feasible.</p>

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Early urinary decompression and mortality in septic obstructing ureteral stones: a nationwide comparative-effectiveness study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月3日

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  • Mohamed Mahmoud Dogha,
  • Atef A. Hassan,
  • Osama Mostafa Mohamed,
  • Mahmoud Farag,
  • Islam S. Nouh,
  • Mohamed Hamdy Ibrahim,
  • Assem Abdelaziz Mesbah,
  • Mohamed F. Elebiary,
  • Nader A Abdelkhalek,
  • Adel Moalwi

摘要

Background

Septic obstructing ureteral stones are a time-critical urological emergency. Although urgent drainage is recommended, uncertainty persists regarding the comparative effectiveness of decompression strategies and the influence of timing in real-world practice.

Methods

We analyzed adults with sepsis or septic shock and obstructing ureteral stones (n = 9,172) from the U.S. HCUP National Inpatient Sample (2016–2022). Exposures included any decompression (ureteral stent or percutaneous nephrostomy [PCN]) versus conservative care, and decompression timing (same-day [day 0] vs. ≥ day 1; ≤ 24 h vs. > 24 h). The primary outcome was in-hospital mortality; secondary outcomes were acute kidney injury (AKI), mechanical ventilation, dialysis, and length of stay. Adjusted associations were estimated using propensity score matching, overlap weighting, instrumental variable (IV) analysis, and landmark/time-dependent survival models with a prespecified 12-variable adjustment set.

Results

Overall mortality was 2.5%. Decompression was associated with lower mortality than conservative care (1.6% vs. 4.0%; risk difference − 2.4% [95% CI − 3.2 to − 1.7]; number needed to treat ≈ 41). Late decompression (> 24 h) versus early (≤ 24 h) was associated with higher odds of mortality (OR 2.17 [1.38–3.41]), AKI, ventilation, and dialysis. In exploratory analyses among decompressed patients, PCN showed higher adjusted mortality than stenting (5.5% vs. 2.8%; OR 2.05 [1.31–3.09]); IV results were directionally consistent but likely reflect residual confounding by indication and feasibility.

Conclusion

Urgent decompression, particularly within 24 h, was associated with lower in-hospital mortality and fewer organ-failure outcomes. Modality differences should be interpreted as hypothesis-generating; PCN remains essential when retrograde stenting is not feasible.