Comparison Between Double J (DJ) Ureteral Stenting and Percutaneous Nephrostomy (PCN) in Obstructive Uropathy

AbstractAcute obstructive uropathy is associated with significant morbidity among patients with any condition that leads to urinary tract obstruction. Immediate urinary diversion is necessary to prevent further damage to the kidneys. In many centres, the two main treatment options include percutaneous nephrostomy (PCN) and retrograde ureteral stenting (RUS). The purpose of this study if to compare the efficacy and safety of PCN and RUS for the treatment of acute obstructive uropathy. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL, EMBASE, the World Health Organisation International Clinical Trials Registry Platform and ClinicalTrials.gov. We also searched the reference lists of included studies to identify any additional trials. We included randomised controlled trials and controlled clinical trials comparing the outcomes of clinical improvement (septic parameters), hospitalisation duration, quality of life, urinary-related symptoms, failure rates, post-procedural pain [measured using a visual analogue scale (VAS)] and analgesics use. We conducted statistical analyses using random effects models and expressed the results as risk ratio (RR) and risk difference (RD) for dichotomous outcomes and mean difference (MD) for continuous outcomes, with 95% confidence intervals (CIs). Seven trials were identified that included 667 patients. Meta-analysis of the data revealed no difference in the two methods in improvement of septic parameters, quality of life, failure rates, post-procedural pain (VAS), or analgesics use. Patients receiving PCN had lower rates of haematuria and dysuria post-operatively and longer hospitalisation duration than those receiving RUS. PCN and RUS are effective for the decompression of an obstructed urinary system, with no significant difference in most outcomes. However, PCN is preferable to RUS because of its reduced impact on the patient’s post-operative quality of life due to haematuria and dysuria, although it is associated with slightly longer hospitalisation duration.

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Impact of palliative urinary diversion by percutaneous nephrostomy drainage and ureteral stenting among patients with advanced cervical cancer and obstructive uropathy: A prospective cohort

Journal of Obstetrics and Gynaecology Research ◽

10.1111/j.1447-0756.2010.01486.x ◽

2011 ◽

Vol 37 (8) ◽

pp. 1061-1070 ◽

Cited By ~ 19

Author(s):

Marie Carmela M. Lapitan ◽

Brian S. Buckley

Keyword(s):

Cervical Cancer ◽

Urinary Diversion ◽

Prospective Cohort ◽

Obstructive Uropathy ◽

Percutaneous Nephrostomy ◽

Advanced Cervical Cancer ◽

Palliative Urinary Diversion ◽

Ureteral Stenting

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Percutaneous Nephrostomy Versus Retrograde Ureteral Stenting for Acute Obstructive Uropathy: A Systematic Review and Meta-Analysis

10.21203/rs.3.rs-127720/v1 ◽

2020 ◽

Author(s):

ZUL KHAIRUL AZWADI ISMAIL ◽

NORHAYATI MOHD NOOR ◽

MOHD SHAFIE ABDULLAH

Keyword(s):

Quality Of Life ◽

Clinical Trials ◽

Obstructive Uropathy ◽

Meta Analysis ◽

Percutaneous Nephrostomy ◽

Procedural Pain ◽

Controlled Trials ◽

Failure Rates ◽

Ureteral Stenting

Abstract Acute obstructive uropathy is associated with significant morbidity among patients with any condition that leads to urinary tract obstruction. Immediate urinary diversion is necessary to prevent further damage to the kidneys. In many centres, the two main treatment options include percutaneous nephrostomy (PCN) and retrograde ureteral stenting (RUS). The purpose of this study if to compare the efficacy and safety of PCN and RUS for the treatment of acute obstructive uropathy. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL, EMBASE, the World Health Organisation International Clinical Trials Registry Platform and ClinicalTrials.gov. We also searched the reference lists of included studies to identify any additional trials. We included randomised controlled trials and controlled clinical trials comparing the outcomes of clinical improvement (septic parameters and hospitalisation duration), quality of life, urinary-related symptoms, failure rates, post-procedural pain [measured using a visual analogue scale (VAS)] and analgesics use. We conducted statistical analyses using random effects models and expressed the results as risk ratio (RR) and risk difference (RD) for dichotomous outcomes and mean difference (MD) for continuous outcomes, with 95% confidence intervals (CIs). Seven trials were identified that included 667 patients. Meta-analysis of the data revealed no difference in the two methods in improvement of septic parameters, quality of life, failure rates, post-procedural pain (VAS), or analgesics use. Patients receiving PCN had lower rates of haematuria and dysuria post-operatively and longer hospitalisation duration than those receiving RUS. PCN and RUS are effective for the decompression of an obstructed urinary system, with no significant difference in most outcomes. However, PCN is preferable to RUS because of its reduced impact on the patient’s post-operative quality of life due to haematuria and dysuria, although it is associated with slightly longer hospitalisation duration.

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Predictors for Retrograde Ureteral Stenting Failure as an Initial Drainage Method for Emergent Complicated Acute Calculus Obstructive Uropathy

Société Internationale d’Urologie Journal ◽

10.48083/ozul6913 ◽

2021 ◽

Vol 2 (4) ◽

pp. 229-238

Author(s):

M.A. Elbaset ◽

Mohamed Edwan ◽

Rasha T. Abouelkhei ◽

Rawdy Ashour ◽

Mohamed Ramez ◽

...

Keyword(s):

Obstructive Uropathy ◽

Percutaneous Nephrostomy ◽

Factors Associated ◽

Patient Demographics ◽

Urinary Drainage ◽

Radiological Data ◽

Ureteric Orifice ◽

Ureteral Stenting ◽

Time Of Admission ◽

Obstructive Pyelonephritis

Objective: To define predictors for initial retrograde ureteral stenting (RUS) failure with the need for the percutaneous nephrostomy (PCN) insertion as a drainage method in patients with complicated acute calculus obstructive uropathy. Methods: We undertook a retrospective evaluation of patients who presented with complicated obstructive calculus uropathy (acute renal failure or obstructive pyelonephritis) between January 2016 and January 2020. Patients in whom there was failure to visualize ipsilateral ureteric orifice and those with extrinsic ureteral obstruction were excluded. Patient demographics and radiological data including stone site, hydronephrosis grade, maximum transverse stone diameter, periureteral density (PUD) and pericalcular ureteric thickness (P-CUT) at the maximum transverse stone diameter were assessed using non-contrast computed tomography at the time of admission. Results: The study included 256 patients who were managed initially by RUS trial. Of them, 48 (18.8 %) had RUS failure. The presence of acute pyelonephritis, increased maximum transverse stone diameter ≥ 9.5 mm, P-CUT ≥ 7.5 mm, and PUD at stone level ≥ 17.5 HU were risk factors associated with RUS failure (P = 0.007, 0.002, < 0.001, and < 0.001, respectively). Conclusion: Initial radiological stone and ureteric characteristics, in addition to the clinical diagnosis of obstructive pyelonephritis, can be used to determine PCN insertion as the preferred option over RUS for urinary drainage.

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