Efficacy and Safety of Double J Stenting (DJS) and Percutaneous Nephrostomy (PCN) in Patients with Obstructive Uropathy
Article Sidebar
Main Article Content
Abstract
Background: Obstructive uropathy is a condition characterized by the blockage of urine flow, which can lead to renal parenchymal damage and, if left untreated, potentially fatal outcomes. The condition arises from various causes, including stone disease, which remains the predominant factor. Management strategies such as Double J Stenting (DJS) and Percutaneous Nephrostomy (PCN) are employed to temporarily alleviate the obstruction, yet the comparative efficacy and safety profiles of these interventions remain to be thoroughly evaluated.
Objective: To compare the efficacy and safety of ultrasound-guided percutaneous nephrostomy and double J stenting in the temporary diversion of urine in patients with obstructive uropathy, with a focus on procedural success rates, complication rates, and overall patient outcomes.
Methods: This randomized controlled trial was conducted at the Department of Urology, Lady Reading Hospital, Peshawar, from January 1st, 2023, to December 31st, 2023. A total of 428 patients with obstructive uropathy, aged between 20 and 60 years, were randomized into two groups: the DJS group (n=214) and the PCN group (n=214). Exclusion criteria included severe coagulopathy and uremic encephalopathy. Efficacy was determined by the resolution of obstruction signs, and safety was assessed by the incidence of complications such as trigonalgia, hematuria, and septicemia within four weeks post-procedure. Statistical analysis was performed using IBM SPSS version 25.
Results: The DJS group demonstrated a procedural success rate of 96.0%, while the PCN group showed a slightly higher success rate of 97.5%. Complication rates were comparably low across both groups, with trigonalgia (28.0% in DJS vs. 25.0% in PCN), hematuria (16.0% in DJS vs. 14.0% in PCN), and septicemia (6.5% in DJS vs. 8.4% in PCN). The efficacy in alleviating obstructive symptoms was 82.2% for DJS and 86.9% for PCN, with no statistically significant difference between the groups (p=0.180).
Conclusion: Both double J stenting and percutaneous nephrostomy are effective and safe methods for temporary urine diversion in patients with obstructive uropathy. Although the PCN group exhibited a slightly higher success rate and a marginally lower complication rate, the differences were not statistically significant, indicating that the choice of procedure can be tailored to the individual patient's condition and the specific clinical scenario.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Martinez-Maldonado M, Kumjian DA. Acute renal failure due to urinary tract obstruction. Med Clin North Am. 2019;74(4):919-32.
D’Angelo A, Prete DD. Urinary tract obstruction. In: Management of acute kidney problems. 2010. p. 53-61.
Peteinaris A, Syllaios A, Schizas D, Davakis S, Kalinterakis G, Fasoulakis Z, et al. Gynecological Benignities Causing Obstructive Uropathy. Review of the Literature. Chirurgia. 2020;115:579-84.
Nayyar R, Sarda AK, Kaza RC, Anand VJ. The obstructed kidney. Indian J Surg. 2005;67(1).
Gadelkareem RA, Abdelraouf AM, El-Taher AM, Ahmed AI. Acute kidney injury due to bilateral malignant ureteral obstruction: Is there an optimal mode of drainage?. World J Nephrol. 2022;11(6):146.
Gauhar V, Pirola GM, Scarcella S, Angelis MV, Giulioni C, Rubilotta E, et al. Nephrostomy tube versus double J ureteral stent in patients with malignant ureteric obstruction. A systematic review and meta-analysis of comparative studies. Int Braz J Urol. 2022;48:903-14.
Cheung KW, Morris RK, Kilby MD. Congenital urinary tract obstruction. Best Pract Res Clin Obstet Gynaecol. 2019;58:78-92.
Becker A, Baum M. Obstructive uropathy. Early Hum Dev. 2006;82(1):15-22.
Ahmad I, Pansota MS, Tariq M, Saleem MS, Tabassum SA, Hussain A. Comparison between double J (DJ) ureteral stenting and percutaneous nephrostomy (PCN) in obstructive uropathy. Pak J Med Sci. 2013;29(3):725.
Pansota MS, Rasool M, Saleem MS, Tabassum SA, Hussain A. Indications and complications of double J ureteral stenting: our experience. Gomal J Med Sci. 2013;11(1).
Ahmad I, Pansota MS, Tariq M. Complication of percutaneous nephrostomy (PCN) in upper obstructive uropathy: Our experience. J Univ Med Dent Coll. 2014;5(1):55-60.
Al-Hajjaj M, Sabbagh AJ, Al-Hadid I, Anan MT, Aljool AA, Husein HA, et al. Comparison complications rate between double-J ureteral stent and percutaneous nephrostomy in obstructive uropathy due to stone disease: a randomized controlled trial. Ann Med Surg. 2022;81:104474.
Ibnouf MM, Bedri I, Hamid KE, Ibnouf MA. Comparison between Double ‘J’Ureteral Stenting versus Percutaneous Nephrostomy in Obstructive Uropathy in Sudan, 2015.
Tibana TK, Grubert RM, Santos RF, Fornazari VA, Domingos AA, Reis WT, et al. Nefrostomia percutânea versus implantação de stent duplo-J anterógrado no tratamento da uropatia obstrutiva maligna: uma análise de custo-efetividade na perspectiva do serviço público de saúde brasileiro. Radiol Bras. 2019;52(5):305-11.
Bhuva S, Kennish SJ, Wah TM. Forgotten indwelling stent in a transplanted kidney: a case report. Cases J. 2009;2:1-4.
Olivares-Amaya R, Watson MA, Edgar RG, Vogt L, Shao Y, Aspuru-Guzik A. Accelerating correlated quantum chemistry calculations using graphical processing units and a mixed precision matrix multiplication library. J Chem Theory Comput. 2010;6(1):135-44.
Mogal K, Mithi M, Kulkarni J. Double J Stenting-Clinical Profile, Indications and Post Operative Complications. MVP J Med Sci. 2021;65-70.
New FJ, Deverill SJ, Somani BK. Outcomes related to percutaneous nephrostomies (PCN) in malignancy-associated ureteric obstruction: a systematic review of the literature. J Clin Med. 2021;10(11):2354.
Venyo AK, Hanley T, Barrett M, Khan AN. Ante-grade ureteric stenting, retrospective experience in managing 89 patients: indications, complications and outcome. J Biomed Graphics Comput. 2014;4(3):47.
Singh CH, Munish T, Sandeep S, Singh AB, Ramneesh G, Simran K, et al. Morbidity associated with ureteral stenting: Study of 90 cases. J Evol Med Dent Sci. 2015;4(31):5349-55.