Introduction

Learning objectives

Recognize the warning signs of a febrile urinary tract infection.
Identify the scenario of an infected obstructed urinary tract.
Understand why urgent drainage takes priority over definitive treatment of the stone.

Video lesson

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Video pending upload (embedded YouTube)

Summary

Pyelonephritis

It is an infection involving the upper urinary tract.

It may present with:

fever;
chills;
flank pain;
nausea or vomiting;
urinary symptoms.

What should we look for?

Not all febrile urinary tract infections carry the same risk.

We should look for signs of:

sepsis;
hypotension;
altered mental status;
renal impairment;
urinary obstruction.

The most dangerous scenario

A patient presents with: fever + flank pain + obstructing ureteral stone.

An obstructive urinary tract infection should be suspected.

In this situation, antibiotics alone may be insufficient.

Treatment

Management includes:

stabilization;
cultures when appropriate;
antibiotics;
evaluation of the urinary tract;
urgent drainage if there is an infected obstruction.

Drainage can be performed by means of:

a ureteral catheter;
percutaneous nephrostomy.

⚠️ Alert

Sepsis + urinary obstruction = urgent drainage.

Drainage must not be delayed in order to perform definitive treatment of the stone.

PDF

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Practical algorithm

Is the patient stable? If not → immediate stabilization.
Is there infection associated with obstruction? If so → antibiotics + urgent drainage.
Is there an organ whose viability is time-dependent? Testicular torsion → urgent surgery. Ischemic priapism → urgent treatment.
Is there an obstruction that needs drainage? Urinary retention → drain the bladder. Retention due to clots → evacuate clots and maintain drainage. Infected urinary obstruction → drain the upper urinary tract.

In urological emergencies, the initial goal is often not to definitively resolve the disease, but to recognize the risk, stabilize the patient, and drain or preserve the organ when appropriate.

Clinical case

Content pending upload Progressive clinical case focused on decision-making.

Self-assessment

Questions pending upload 5–10 multiple-choice questions on this lesson.

References

Links pending upload References to PubMed, DOI, scientific society guidelines and journals.

Pyelonephritis and urosepsis