, Volume 47, Issue 6, pp 567–573 | Cite as

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

  • Nuno de Sousa MoraisEmail author
  • José P. Pereira
  • Paulo Mota
  • Emanuel Carvalho-Dias
  • João N. Torres
  • Estêvão Lima
Original Paper


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.


Urolithiasis 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.

Ethical approval

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.

Informed consent

Signed informed consent was obtained from all the individual participants included in this study.

Supplementary material

240_2018_1078_MOESM1_ESM.pdf (101 kb)
Supplementary material 1 (PDF 100 KB)
240_2018_1078_MOESM2_ESM.pdf (69 kb)
Supplementary material 2 (PDF 68 KB)


  1. 1.
    Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA (2016) Campbell-Walsh urology, 11th edn. Elsevier Health Sciences, PhiladelphiaGoogle Scholar
  2. 2.
    Trinchieri A (2008) Epidemiology of urolithiasis: an update. Clin Cases Miner Bone Metab 5(2):101–106 (PMC2781200) PubMedPubMedCentralGoogle Scholar
  3. 3.
    Romero V, Akpinar H, Assimos DG (2010) Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol 12(2–3):e86–e96 (PMC2931286)PubMedPubMedCentralGoogle Scholar
  4. 4.
    Uribarri J, Oh MS, Carroll HJ (1989) The first kidney stone. Ann Intern Med 111(12):1006–1009PubMedCrossRefGoogle Scholar
  5. 5.
    Türk AN C, Petrik A, Seitz C, Skolarikos A, Tepeler A, Thomas K, Dabestani S, Drake T, Grivas N, Ruhayel Y (2017) EAU Guidelines on Urolithiasis. In: present at EAU Annual Congress London 2017, editor. EAU Guidelines Office, Arnhem. Google Scholar
  6. 6.
    Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP et al (2016) Surgical management of stones: American Urological Association/Endourological Society Guideline. J Urol 196(4):1153–1169PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Ramsey S, Robertson A, Ablett MJ, Meddings RN, Hollins GW, Little B (2010) Evidence-based drainage of infected hydronephrosis secondary to ureteric calculi. J Endourol 24(2):185–189PubMedCrossRefGoogle Scholar
  8. 8.
    Goldsmith ZG, Oredein-McCoy O, Gerber L, Banez LL, Sopko DR, Miller MJ et al (2013) Emergent ureteric stent vs percutaneous nephrostomy for obstructive urolithiasis with sepsis: patterns of use and outcomes from a 15-year experience. BJU Int 112(2):E122–E128PubMedCrossRefGoogle Scholar
  9. 9.
    Pearle MS, Pierce HL, Miller GL, Summa JA, Mutz JM, Petty BA et al (1998) Optimal method of urgent decompression of the collecting system for obstruction and infection due to ureteral calculi. J Urol 160(4):1260–1264PubMedCrossRefGoogle Scholar
  10. 10.
    Cohen J (2013) Statistical power analysis for the behavioral sciences. Taylor & Francis, RoutledgeCrossRefGoogle Scholar
  11. 11.
    Kotrlik JW, Williams HA (2003) The incorporation of effect size in information technology, learning, and performance research. Inform Technol Learn Perform J 21(1):1–7Google Scholar
  12. 12.
    Mokhmalji H, Braun PM, Martinez Portillo FJ, Siegsmund M, Alken P, Kohrmann KU (2001) Percutaneous nephrostomy versus ureteral stents for diversion of hydronephrosis caused by stones: a prospective, randomized clinical trial. J Urol 165(4):1088–1092PubMedCrossRefGoogle Scholar
  13. 13.
    Yoshimura K, Utsunomiya N, Ichioka K, Ueda N, Matsui Y, Terai A (2005) Emergency drainage for urosepsis associated with upper urinary tract calculi. J Urol 173(2):458–462PubMedCrossRefGoogle Scholar
  14. 14.
    Coll DM, Varanelli MJ, Smith RC (2002) Relationship of spontaneous passage of ureteral calculi to stone size and location as revealed by unenhanced helical CT. AJR Am J Roentgenol 178(1):101–103PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Jendeberg J, Geijer H, Alshamari M, Cierzniak B, Liden M (2017) Size matters: the width and location of a ureteral stone accurately predict the chance of spontaneous passage. Eur Radiol 27(11):4775–4785 (PMC5635101) PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Leibovici D, Cooper A, Lindner A, Ostrowsky R, Kleinmann J, Velikanov S et al (2005) Ureteral stents: morbidity and impact on quality of life. Isr Med Assoc J 7(8):491–494PubMedGoogle Scholar
  17. 17.
    Joshi HB, Adams S, Obadeyi OO, Rao PN (2001) Nephrostomy tube or ‘JJ’ ureteric stent in ureteric obstruction: assessment of patient perspectives using quality-of-life survey and utility analysis. Eur Urol 39(6):695–701PubMedCrossRefGoogle Scholar
  18. 18.
    Joshi HB, Stainthorpe A, MacDonagh RP, Keeley FX Jr, Timoney AG, Barry MJ (2003) Indwelling ureteral stents: evaluation of symptoms, quality of life and utility. J Urol 169(3):1065–1069 (discussion 69) PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Urology DepartmentHospital de BragaBragaPortugal
  2. 2.School of MedicineMinho UniversityBragaPortugal

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