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Septic Obstructed Stone Emergency — ESENeph MCQ

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HardRenal Stone DiseaseSeptic Obstructed Stone EmergencyESENeph

A patient with fever, hypotension and AKI has an 8 mm ureteric stone obstructing a hydronephrotic kidney. What intervention is most urgent?

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Correct answer: D — Decompress by ureteric stent or nephrostomy and give antibiotics

The best answer is “Decompress by ureteric stent or nephrostomy and give antibiotics”. Infected obstruction is a urological emergency. Drainage and antimicrobial resuscitation precede definitive stone treatment. “Arrange definitive stone treatment after sepsis and obstruction have resolved” is less appropriate because definitive fragmentation waits until infection is controlled “Continue antibiotics while monitoring response without immediate drainage” is less appropriate because antibiotics cannot reliably sterilize an obstructed collecting system “Arrange metabolic stone assessment after the acute episode has resolved” is less appropriate because this delays life-saving source control “Use open drainage when less invasive decompression is not technically feasible” is less appropriate because stent or nephrostomy can provide urgent minimally invasive decompression

Reference: NICE NG118: renal and ureteric stones: https://www.nice.org.uk/guidance/ng118/chapter/recommendations