Abu Dhabi, United Arab Emirates (UroToday.com) Dr. Christopher Haas outlined his groups’ experience at Columbia with the implementation of a hospital-wide protocol regarding the management of patients with obstructive pyelonephritis. This was a protocol implemented by both urology and interventional radiology, that enabled urologists to more swiftly engage interventional radiology for nephrostomy tube decompression. Patients with obstructive pyelonephritis related sepsis have an over 2-fold mortality risk when not treated with decompression by nephrostomy tube or retrograde ureteral stenting. Consequently, these patients require urgent decompression.

In this protocol, patients with obstruct pyelonephritis with sepsis were identified. If an anatomic variation made retrograde access difficult, percutaneous nephrostomy tube placement was attempted. If no anatomic variation but hydronephrosis was present, this attempt was also made. If no anatomic variation, hydronephrosis, but the patient is unstable for general anesthesia, the attempt for PCN placement was made. If the patient is stable enough for general anesthesia, retrograde stenting was performed.

Implementation of the protocol resulted in an increase in the rate of nephrostomy tube utilization from 4.5 per year to 18 per year. The median time from urologic consultation to nephrostomy tube placement decreased from 7.3 hours to 4.3 hours. It also resulted in a shorter median length of stay after the implementation of the protocol. Based on these results, the protocol made it more likely that a nephrostomy tube was used in a quick manner. This was determined by looking at all patients at their institution who underwent nephrostomy tube placement between 2012 and 2017 or retrograde ureteral stenting from 2014-2017. The protocol was implemented in May 2016.

Presentation of this topic led to a discussion on how well organized protocols can improve efficiency in hospitals. These protocols can also enhance collaborative efforts between different hospital teams such as urology and interventional radiology.

Presented by: Christopher Haas, MD, Department of Urology, Columbia University, New York, New York, USA.

Written by Rajiv Karani (Department of Urology, University of California, Irvine) at the 37th World Congress of Endourology (WCE) – October 29th-November 2nd, Abu Dhabi, United Arab Emirates