Comparison complications rate between double-J ureteral stent and percutaneous nephrostomy in obstructive uropathy due to stone disease:A randomized controlled trial. (September 2022)

• Record Type: Journal Article
• Authors: Al-Hajjaj, Maher; Sabbagh, Aziz Joseph; Al-Hadid, Ibrahim; Anan, Mohamed Taher; Nour kazan, Mohammad; Alali Aljool, Ali; AL Muhammad AL Husein, Hasan; Tallaa, Mohamed
• Is Part Of: Annals of medicine and surgery. Volume 81(2022)
• Publication Date: 2022-09
• Subjects: Obstructive uropathy -- Nephrolithiasis -- Double j stent -- Nephrostomy; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2022.104474
• Languages: English
• ISSNs: 2049-0801

Abstract

Abstract: Background: Obstructive uropathy due to stone disease is seen every day in urological practice. Percutaneous nephrostomy and double j ureteral stent procedures are used. Methodology: A randomized controlled trial was conducted in one center from January 2021 to January 2022. A total of 104 patients of age ≥18 years who had unilateral or bilateral obstructive uropathy due to stone disease were divided into two groups. In Group A, 50 patients underwent to double j stent while in Group B, 54 patients who underwent percutaneous nephrostomy insertion tube. Under local anesthesia, the stent was inserted by cystoscopy. While the percutaneous nephrostomy was done under ultrasound guidance by using local anesthetic agent. Complications were noted in immediate postoperative period and on follow up. Results: Mean age of Group A was 35 ± 12.7 years whereas mean age in Group B was 36.7 ± 12.5 years and 49 out of patients were male. The most common complication in double j group and nephrostomy group was hematuria (16% and 5.5% respectively). Post DJ stent, complications like septicemia, painful trigon irritation, and stent encrustation were seen in 8.0%, 10.0%, 10.0% and 4.0% patients respectively. On the other hand, post-PCN septicemia, tube dislodgment or blockage, and injury to adjacent organs were seen in 3.7%, 5.5% and 1.8% respectively. In our trial, overall success rate for double j stenting was up to 84.0% and for percutaneous nephrostomy (PCN) was 96.29% (p < 0.0001). Conclusion: We found percutaneous nephrostomy is better and had overall higher success rate with less complications post procedure. Highlights: Obstructive uropathy is a common urological condition seen in urology. Stone disease is the most common cause of obstructive uropathy. Percutaneous nephrostomy and retrograde double j stent are common procedures for reliving the urological obstruction. To these days, there is superiority of one procedure on the other. In addition, no clear guideline support one procedure instead the other.