Efficacy and Safety of Double J Stenting (DJS) and Percutaneous Nephrostomy (PCN) in Patients with Obstructive Uropathy

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.