Comparison Between Bedside and Traditional Operative Placement of Ureteral Stent for Acute Obstructive Pyelonephritis: A Retrospective Cohort Study.

Abstract

Purpose: Previous studies have demonstrated the feasibility of bedside placement of ureteral stents in cases of acute ureteral obstruction. However, there is a lack of evidence comparing its efficacy to traditional stent placement in the operating room with fluoroscopy. We compared the clinical outcomes of bedside ureteral stent placement with the current standard of care. Methods: A retrospective cohort study included patients with acute obstructive pyelonephritis from July 2023 to July 2024. Exclusion criteria included patients not requiring hospital admission, absence of obstructing ureteral calculi, and absence of sepsis criteria. Baseline demographics, including the degree of sepsis and stone characteristics, were measured. Outcomes included time to decompression, successful stent placement, and hospital duration. Results: A total of 55 patients were included, of which 17 underwent bedside ureteral stenting and underwent operative stent placement. No significant differences were found in baseline demographics, sepsis criteria measures, stone characteristics, or degree of hydronephrosis between the groups. Patients in the bedside group had reduced time to stenting (216.0, Q1-Q3: 4.5-408.5 minutes vs 319.0, Q1-Q3: 174-792 minutes, p = 0.040) and achieved higher rates of urine aspirate retrieval (100% vs 76%, p = 0.028) compared with the operating theater group. There were no statistically significant differences in the stent success rates (100% vs 95%, p = 0.344) or complication rates (0% vs 3%, p = 0.500) between the two groups. Conclusions: Bedside stent placement offers faster source control and reliable urine aspirate retrieval while maintaining comparable success and complication rates to stenting in the operating theater for patients with obstructive pyelonephritis.