Ureteric stent versus percutaneous nephrostomy for acute ureteral obstruction - clinical outcome and quality of life: a bi-center prospective study

Abstract

Background To compare quality of life (QoL) indices between ureteral stent (DJS) and nephrostomy tube (PCN) inserted in the setting of acute ureteral obstruction. Methods Prospective bi-centered study. Over the span of 2 years, 45 DJS and 30 PCN patients were recruited. Quality of life was assessed by 2 questionnaires, EuroQol EQ-5D and ‘Tube symptoms’ questionnaire, at 2 time points (at discharge after drainage and before definitive treatment). Results Patients’ demographics and pre-drainage data were similar. There were no clinically significant differences in patient’s recovery between the groups, including post procedural pain, defeverence, returning to baseline renal function, and septic shock complications. More DJS patients presented to the emergency room with complaints related to their procedure compared to PCN patients. At first, DJS patients complained more of urinary discomfort while PCN patients had worse symptoms relating to mobility and personal hygiene, with both groups achieving similar overall QoL score. At second time point, PCN patients’ symptoms ameliorated while symptoms in the DJS group remained similar, translating to higher overall QoL score in the PCN group. Conclusions The two techniques had a distinct and significantly different impact on quality of life. Over time, PCN patients’ symptoms relieve and their QoL improve, while DJS patients’ symptoms persist. Specific tube related symptoms, and their dynamics over time, should be a major determinant in choosing the appropriate drainage method, especially when definitive treatment is not imminent. Electronic supplementary material The online version of this article (10.1186/s12894-019-0510-4) contains supplementary material, which is available to authorized users.

Hounsfield unit attenuation value can differentiate pyonephrosis from hydronephrosis and predict septic complications in patients with obstructive uropathy

“…Second, the decision to place a nephrostomy tube or a DJ was based on physician/patient preference and individuals’ clinical factors. We did not find any difference in preoperative and postoperative parameters according to the type of urinary drainage (data not shown) and previous reports showed no difference in septic complications after DJ or nephrostomy tube insertion in the setting of acute ureteral obstruction 26 . However, we cannot exclude that the difference in the urine collection method might have an impact on infectious outcomes in this cohort of patients.…”

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

“…Two trials analysed parameters of clinical success, which included septic parameters and hospitalisation duration in patients with obstructive uropathy 8,12 . Three trials reported patients' quality of life and urinary-related symptoms 9,13,14 . For the secondary outcomes, three trials reported failure rates 5,8,10 , two trials reported postprocedural pain 8,14 and four trials reported analgesics use 5,9,13,14 .…”

“…All trials that reported quality of life used a similar questionnaire, that is, the EuroQol EQ-5D-3L® 9,14,15 , which is the three-level version of the EQ-5D. This measure includes a descriptive system that contains five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression.…”

“…The total number of participants was 667. Four of the trials were conducted in the urology departments from referral cases 5,10,12,14 , two trials included patients who presented to the emergency department 8, 13 and one trial included patients referred to a stone management unit 9 . One multicentre trial was conducted in urology units in Germany and Syria 5 .…”

“…One multicentre trial was conducted in urology units in Germany and Syria 5 . Two trials were RCTs 5,10 , whereas five were CCTs 8,9,[12][13][14] .…”