Use of percutaneous nephrostomy and ureteral stenting in management of ureteral obstruction

Table 2 Percutaneous nephrostomy vs retrograde stent utilization in ureteral stone disease obstruction

Ref.	Study design	Cohort	Diagnosis	Stent	Complication	Nephrostomy	Complications	Conclusions
Ahmad et al[23], 2013	Retrospective, 2010-2011	n = 300 (20/100 (stent) and 36/200 (PCN) had malignant obstruction)	NR	97/100 had successful placement, 3 proceeded to have PCN	37/97 (38%) complication rate (7 fever/sepsis, 10 bleeding/hematuria, 12 pain/irritation, 1 ureteral perforation, 2 stent migration, 5 stone encrustation	195/200 had successful PCN placement	25/195 (12.8%) complication rate (7 fever/sepsis, 9 bleeding/hematuria, 9 dislodgement)	PCN had lower incidence of complications as compared to stenting
Goldsmith et al[36], 2013	Retrospective, 1995-2011	n = 130 patients with infected urolithiasis who underwent procedural decompression	CT and 2/4 SIRS criteria	69/71 successful stent placement, 2 proceeded to PCN	NR	58/59 successful PCN placement, 1 proceeded to retrograde stent	NR	Patients selected for PCN had larger stones and were more severely ill. Patients who underwent PCN had longer hospital stay on multivariable analysis. Time from septic event to definitive treatment, rates of spontaneous stone passage, and initiation of metabolic stone workup were the same between the two groups
Joshi et al[41], 2001	Prospective, non-randomized	n = 34 patients (22 male) with obstructing ureteral stones	X-ray, US, IV urography	21	NR	13	NR	Stent patients were more likely to report hematuria, dysuria, urgency as compared to PCN patients. Stent patients required analgesics more frequently than the PCN group. Patients in the PCN required more daily care as compared to stent patients. EuroQOL questionnaire revealed differences in mobility, self care, and problems with usual activity and pain between the two cohorts but no significant differences in overall QOL
Mokhmalji et al[38], 2001	Prospective randomized, 1996-1998	n = 40 patients with ureteral stone and evidence of infection	Imaging modality NR and 1 major (renal colic, fever, ston e > 15 mm, sepsis and elevated Cr > 1.7 mg/dL) or 2 minor criteria (lower UTI, wbc change, diminished patient compliance)	16/20 successfully underwent stent placement	Fluoroscopy exposure > 2 min (40%), IV analgesics (35%)	20/20 underwent initial PCN, 4/20 underwent subsequent PCN due to failed attempted stent	Fluoroscopy > 2 min (10%), IV analgesics (10%)	Time to definitive therapy was longer in stent group as compared to PCN group due to persistent signs of urinary tract infection. Unsuccessful stent placement occurred in older patients and with stones located in proximal ureter. No statistical differences in QOL but a trend to lower QOL was seen in stent patients who were male or < 40 yr
Pearle et al[40], 1998	Prospective randomized, 1995-1997	n = 42 patients with ureteral stone and evidence of infection	IV pyelography, US, X-ray, CT, or retrograde pyelography with WBC > 17000 mm or temperature > 38 °C	21 underwent successful stent placement		20/21 underwent successful PCN, 1 proceeded to undergo retrograde stent placement		Fluoroscopy and procedural times shorter in stent vs PCN cohort. Higher number of positive urine cultures post-PCN was noted as compared to post-stent placement. Length of stay, blood culture positivity, and time to WBC and temperature normalization were not statistically different. Costs associated with stent placement more than twice of that of PCN. Increased back pain noted in PCN group
Yoshimura et al[37], 2004	Retrospective, 1994-2003	n = 53 (59 events) patients underwent emergency drainage with ureteral stones and SIRS criteria	NR	35 stent events	NR	24 PCN events	NR	Patients who underwent stent had smaller stones but similar rates of ICU management as compared to PCN

SIRS: Systemic inflammatory response syndrome; QOL: Quality of life; US: Ultrasound; IV: Intravenous; WBC: White blood cell count; NR: Not reported/studied; ESWL: Extracorporeal shock-wave lithotripsy.