Effect of Emergency Urinary Drainage on Subsequent PCNL Outcomes in Obstructive Urosepsis

Patients presenting to the emergency department with obstructive upper urinary tract stones and urosepsis will be prospectively enrolled. Initial emergency management includes hemodynamic resuscitation, broad-spectrum intravenous antibiotic therapy, and emergency decompression of the collecting system using either retrograde ureteral stent (RUS) insertion or percutaneous nephrostomy (PCN) based on surgeon judgment and clinical feasibility.

Following complete clinical resolution of sepsis, normalization of inflammatory markers, and confirmation of a sterile urine culture, patients will undergo definitive percutaneous nephrolithotomy (PCNL) under general anesthesia. Operative parameters including access technique, dilation, fragmentation method, operative time, and hemoglobin drop will be recorded. Postoperatively, complications will be graded according to the Clavien-Dindo classification system. Stone-free status (defined as the absence of residual fragments or fragments ≤ 4 mm) will be assessed at 2-4 weeks postoperatively using non-contrast computed tomography (NCCT) or ultrasonography.

Inclusion criteria

• Age 18 years or older.
• Presence of renal or proximal ureteral stones.
• Presentation with urosepsis secondary to obstructive urolithiasis.
• Emergency urinary decompression performed by either retrograde ureteral stent (Double-J stent) or percutaneous nephrostomy (PCN).
• Patients scheduled for definitive stone management via percutaneous nephrolithotomy (PCNL) after clinical stabilization and infection resolution.
• Written informed consent obtained prior to enrollment.

Exclusion criteria

• Congenital renal anomalies (e.g., horseshoe kidney, ectopic kidney).
• Pregnancy.
• Uncorrectable coagulopathy or bleeding disorders.
• Active, uncontrolled urinary tract infection at the time of definitive PCNL.
• Severe cardiopulmonary comorbidities rendering the patient unfit for surgery or general anesthesia.
• Patients managed definitively by other modalities (e.g., ureteroscopy or ESWL alone).