Choice of urinary tract drainage in different age groups of patients with urolithiasis

Retro- and prospective analyses of 802 case histories of patients with nephrostomic drainage (n = 272), ureteral catheter (n = 27) and ureteral stent (n = 503) treated for urolithiasis in the urological department of M.F. Vladimirsky Moscow Region Research Clinical Institute and Zhukovsky city hospital hospitalized in 1995 to 2009 made it possible to develop algorithms of choice of upper urinary tract drainage depending on clinical and laboratory indices. Nephrostomic drainage is preferable in a single functioning kidney, acute obstructive pyelonephritis, anuria, hyperthermia above 38°C, marked supravesical urodynamic disorder, in renal failure, serum creatinine over 200 mcmol/l, urea over 10 mmol/l, blood potassium over 5 mmol/l, uric acid over 380 mcmol/l and leukocytosis over 8x109 l. Draining with ureteral stent was used primarily in elective surgery - extracorporeal shock-wave lithotripsy and transurethral operations. Stenting was better tolerated and entailed less frequent complications. In the rest cases choice of drain method should be made by the urologist. In active inflammation, before getting antibioticogram, the drain should be followed by antibiotic treatment with fluoroquinolones, cephalosporines of the third or forth generation, aminoglycosides, carbapenems in standard doses.

old age, urolithiasis, nephrostomic draining, ureteral stent, renal drainage