Percutaneous nephrostomy vs ureteral stent for hydronephrosis secondary to ureteric calculi: impact on spontaneous stone passage and health-related quality of life—a prospective study
Ureteral calculi can be associated with urinary drainage blockage, requiring urinary diversion with percutaneous nephrostomy (PCN) or retrograde ureteral stent (RUS). Currently no evidence exists to support the superiority of one method over the other. This study proposes to compare both approaches regarding the probability of spontaneous stone passage (SSP) and its effect on patient’s quality of life (QoL). A prospective trial was carried out from July to October of 2017. 50 patients were selected with hydronephrosis secondary to ureteral stones requiring urgent urinary diversion and divided into two groups according to diversion technique: percutaneous nephrostomy (PCN) or retrograde ureteral stent (RUS). The rate of SSP and QoL were evaluated. A PCN group (18 patients) and a RUS group (32 patients) were set. Stone size was higher in PCN (median 92 mm2) than RUS (median 47 mm2) (p = .012). The rate of SSP was 25% in RUS group and 38.9% in PCN. On the univariable analysis no statistical effect was found; however, when adjusted for stone size, location, previous ureteral manipulation and expulsive therapy, PCN showed a significant higher chance of SSP than RUS (OR = 6667). Besides, it was found that 30.2% (n = 13) of stones had an upward displacement associated with retrograde endoscopy. A significant decrease between pre- and post-intervention QoL was found with RUS (p < .001), but not found with PCN (p = .206). Patients in RUS group experienced more urinary symptoms, mostly haematuria (68.7% vs 16.7% in PCN group < .001) and dysuria (78.3% vs 16.7% in PCN group, p < .001). PCN was associated with a higher rate of spontaneous stone passage when adjusted for stone size and location. Moreover, PCN was better tolerated and associated with fewer urinary symptoms when compared with RUS.
KeywordsUrolithiasis Percutaneous nephrostomy Ureteral stent Quality of life Spontaneous passage
There were no funding resources obtained for this study.
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflicts of interest or some affiliations with any organization or entity with financial or non-financial interest in the subjects discussed in this work.
All procedures performed in our study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Signed informed consent was obtained from all the individual participants included in this study.
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