From the Guidelines
Antibiotics should only be used in patients with ureteropelvic junction (UPJ) obstructive stones who show signs of urinary tract infection or sepsis, as indicated by symptoms such as fever, chills, or abnormal urinalysis, and the choice of antibiotic should be guided by the most recent guidelines and local resistance patterns, as recommended by the European Association of Urology guidelines on urological infections 1. When infection is suspected, empiric antibiotic therapy should be initiated promptly, with common choices including fluoroquinolones, such as ciprofloxacin 500mg twice daily or levofloxacin 750mg once daily, trimethoprim-sulfamethoxazole (160/800mg twice daily), or a third-generation cephalosporin like ceftriaxone (1-2g daily) 1. For more severe cases or sepsis, intravenous antibiotics such as piperacillin-tazobactam (3.375g every 6 hours) or meropenem (1g every 8 hours) may be necessary, as outlined in the guidelines for complicated urinary tract infections 1. The primary management for UPJ stones focuses on pain control, hydration, and definitive stone removal through urological procedures rather than antibiotics, and antibiotics are only indicated when bacterial infection complicates the stone, as unnecessary antibiotic use can lead to resistance and adverse effects, as noted in the European Association of Urology guidelines 1. Urine cultures should guide antibiotic selection whenever possible to ensure targeted therapy, and the treatment duration typically ranges from 7-14 days depending on severity, as recommended in the guidelines for urinary tract infections 1. In cases where patients have signs of sepsis or complicated urinary tract infection, a combination of antibiotics, such as amoxicillin plus an aminoglycoside, or an intravenous third-generation cephalosporin, may be used as empirical treatment, as outlined in the guidelines for complicated UTIs 1. It is essential to manage any urological abnormality and/or underlying complicating factors, as recommended in the guidelines for urinary tract infections 1. The choice of antibiotic should be based on local resistance patterns and optimized, as recommended in the European Association of Urology guidelines on urological infections 1. In addition to antibiotic therapy, patients with UPJ obstructive stones may require other interventions, such as percutaneous nephrostomy (PCN) or retrograde ureteral stenting, to manage the obstruction and prevent further complications, as discussed in the ACR Appropriateness Criteria for radiologic management of urinary tract obstruction 1. However, the use of antibiotics should always be guided by the presence of infection or sepsis, and not solely by the presence of a stone or obstruction, as recommended in the guidelines for urinary tract infections 1. Overall, the management of UPJ obstructive stones requires a comprehensive approach that includes pain control, hydration, definitive stone removal, and targeted antibiotic therapy when indicated, as recommended in the European Association of Urology guidelines on urological infections 1.
From the Research
Ureteropelvic Junction Obstruction and Renal Stones
- Ureteropelvic junction obstruction (UPJO) is a condition characterized by impaired flow of urine from the renal pelvis to the ureter, which can lead to renal impairment if left untreated 2.
- The management of UPJO often involves surgical techniques, including open pyeloplasty, laparoscopic pyeloplasty, and robot-assisted pyeloplasty, with the goal of relieving the obstruction and improving renal function 3.
Treatment Options for UPJO with Concomitant Renal Stones
- The simultaneous surgical management of UPJO with concomitant renal stones has evolved over the years, with minimally invasive techniques such as laparoscopic and robot-assisted laparoscopic operations becoming increasingly popular 4.
- These techniques allow for precise surgical maneuvers and can simplify the reconstruction steps of the procedure, especially in complex cases with large stones 4.
- The available evidence suggests that both laparoscopic and robotic-assisted techniques offer excellent surgical solutions in the field of UPJO reconstruction and renal stones removal, with high stone-free rates and UPJ patency 4.
Role of Antibiotics in UPJO with Obstructive Stone
- There is no direct mention of the use of antibiotics in the treatment of UPJO with obstructive stone in the provided studies.
- However, it is generally recommended to use antibiotics in cases of urinary tract infection (UTI) associated with UPJO, as UTI can be a complication of the obstruction 5.
- The use of antibiotics in the management of UPJO with concomitant renal stones is not explicitly mentioned in the provided studies, but it may be considered in cases where there is a high risk of infection or in patients with a history of UTI 4.