Infected obstructed kidney — ESENeph MCQ

Correct answer: C — Urgent drainage plus antibiotics and cultures

The best answer is “Urgent drainage plus antibiotics and cultures”. Sepsis with an obstructed collecting system requires immediate antibiotics, cultures and urgent drainage by stent or nephrostomy. Definitive stone treatment follows after sepsis has cleared. “Attempt definitive ureteroscopy before treating sepsis” is less appropriate because definitive stone removal is delayed until infection has resolved “Use oral alpha-blocker monotherapy and review in one week” is less appropriate because sepsis and anuria make conservative passage unsafe “Give intravenous fluid without obtaining drainage or cultures” is less appropriate because resuscitation is necessary but does not control the obstructed infected source “Wait for spontaneous stone passage because the stone is below 10 mm” is less appropriate because an infected obstructed solitary kidney is a urological emergency independent of stone size

Reference: EAU 2026 urolithiasis guideline: https://uroweb.org/guidelines/urolithiasis/chapter/guidelines