Acute kidney injury due to bilateral malignant ureteral obstruction: Is there an optimal mode of drainage?

Table 2 Comparison between the drainage of kidneys with malignant ureteral obstruction by percutaneous nephrostomy vs double-J stent approach

1Variables	Drainage by PCN	Drainage by JJ
Design of catheter
Manufacturing characteristics	One-end coil kidney tube, with a need for fixation to the skin or change by a Foley catheter after tract establishment	Two-coil self-retaining internal ureteral catheter
		Material: different, including polymeric and metallic types
	Material: polymeric materials
Route of drainage	Drain the kidney to outside the body	Drain the kidney to urinary bladder
Length	Suitable to the skin-to-pelvicalyceal distance	Suitable to the ureteral length
Mechanism of drainage	Catheter lumen only	Ureteral lumen plus catheter lumen
Procedure/Technique
Armamentarium required	Needs radiological or ultrasonographic localization of the target calyx	Needs endoscopic armamentarium; C-arm and cystoscope
Approach	External and artificial	Internal and natural/artificial (antegrade)
Anesthesia	Mostly local	Local, epidural, or spinal
Feasibility	Independent on ureteral patency	Dependent on ureteral patency
	Equally feasible to external and internal MUO	More feasible to external (compressive) MUO
Procedural time	Longer	Shorter
Preference and indications	The advanced stages	The early stages
Success rate	High; up to 96%–100%	Relatively low, up to 85%
Drainage and complications
Complications	They are dependent on the non-natural route (more invasive), with a greater incidence of injury of adjacent organs, hemorrhage, discomfort, obstruction, and accidental tube displacement	They are dependent on the internal route, with higher possibilities of LUTS, UTI, hematuria, and potential obstruction by underlying malignancy
Mechanism of failure of drainage	Mainly due to lumen obstruction by thick urinary contents and tube slippage	Mainly due to compression of the ureteral and stent lumens by the underlying malignancy
Effects on the outcomes
Kidney drainage and decompression	No statistical differences, but it is better with PCN, especially with infections	Lower efficacy
Normalization of functions	No difference
Patient survival	No difference
Hospital stay	Longer	Shorter
Periodical change of catheter	No difference
Overall rate of complications	No difference
Potential effect on quality of life	Higher due to external nature of urine drainage	Lower due to internal nature of drainage

¹The variables, classifications, and information provided in this table are drawn from the current literature, specifically within the last two decades[9,12-14,17,21,33,43,44].

MUO: Malignant ureteral obstruction; JJ: Double-J stent; LUTS: Lower urinary tract symptoms; PCN: Percutaneous nephrostomy; UTI: Urinary tract infection.