Comparison Between Double J (DJ) Ureteral Stenting and Percutaneous Nephrostomy (PCN) in Obstructive Uropathy

Iftikhar Ahmad,Mudassar Saeed Pansota

doi:10.12669/pjms.293.3563

Abstract

To compare the complications rate of percutaneous nephrostomy and double J ureteral stenting in the management of obstructive uropathy. Total number of 300 patients of age 20-80 years who underwent JJ stenting or percutaneous nephrostomy for obstructive uropathy were included in this study. Patients were divided in two groups i.e. A & B. In group A, 100 patients who underwent double J ureteral stenting while in group B, 200 patients who underwent percutaneous nephrostomy tube insertion were included. The stent was inserted retrograde by using cystoscope, under mild sedation or local anesthesia. While the percutaneous nephrostomy was done under ultrasound guidance by using local anesthetic agent. Complications were noted in immediate post-operative period and on follow up. Majority of the patients were between 36 to 50 years of age with male to female ratio was 2.6:1. The most common cause of obstructive uropathy was stone disease i.e. renal, ureteric or both. Post DJ stent, complications like painful trigon irritation, septicemia, haematuria and stent encrustation were seen in 12.0%, 7.0%, 10.0% and 5.0% patients respectively. On the other hand, post-PCN septicemia, bleeding and tube dislodgment or blockage was seen in 3.5%, 4.5% and 4.5% respectively. In this study, overall success rate for double J stenting was up to 83.0% and for percutaneous nephrostomy (PCN) was 92.0% (p<0.0001). Percutaneous nephrostomy is a safe and better method of temporary urinary diversion than double J stenting for management of obstructive uropathy with lower incidence of complications.

Highlights

After approval from ethical review committee, total number of 300 patients of obstructive uropathy who underwent double J stenting or percutaneous nephrostomy were included in this study
The most common cause of obstructive uropathy was stone disease i.e. renal, ureteric or both and 75.0% patients in group A and 65.0% in group B, presented with it followed by other causes i.e. carcinomas, pyonephrosis and PUJ obstruction as shown in Table-II
After double J ureteral stenting (Group A), Fever and septicemia occurred in 07 patients

Summary

INTRODUCTION

Obstructive uropathy is the structural impedance to the flow of urine and can occur at any level from uretheral meatus to the calyceal infundibula. In young and middle age patients’ renal calculi are the main etiological factors of obstruction.[2] In female, Gynaecological tract obstruction and obstetrical trauma while in old people, malignancy contributes to upper obstructive uropathy.[2,3] It is a potentially life threatening condition and if the obstruction is present bilaterally, immediate measures are required to decompress the kidney, otherwise the patient’s clinical conditions will deteriorate at a fast pace[4] through uremia, water-electrolyte abnormalities and urinary infections with a consequent reduction of alertness and subsequent death.[3,5] Urinary diversion is one of the ways to manage ureteral obstructions and is commonly performed in our daily practice when the underlying pathology of ureteral obstruction cannot be eliminated in a short period. This study was conducted to compare the complications rate of ultrasound guided percutaneous nephrostomy (PCN) and double J (DJ) ureteral stenting in the management of obstructive uropathy

METHODOLOGY

RESULTS

DISCUSSION

CONCLUSION

REFRENCES