A patient with a ureteric stone, fever and a raised white cell count has pus behind an obstruction. Antibiotics alone cannot reach it, and ureteroscopy or lithotripsy at this stage risks septic shock. The kidney needs decompression — a ureteric stent or a percutaneous nephrostomy — as an emergency, with definitive stone treatment deferred until the infection has settled.
- Treat fever with an obstructing stone as a urological emergency.
- Take blood and urine cultures and start intravenous antibiotics immediately.
- Decompress with a ureteric stent or percutaneous nephrostomy, whichever is quicker locally.
- Do not attempt definitive stone removal during active infection.
- Watch for septic shock; involve critical care early in an unwell patient.
Why it matters
Delay in decompressing an infected, obstructed kidney is a leading preventable cause of urosepsis deaths.
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