Efficacy of Percutaneous Nephrostomy Tube During Ureteroscopy for Upper Ureter Stone Management

Abstract

Preoperative percutaneous nephrostomy (PCN) has been commonly performed for patients with urinary stones complicated with pyelonephritis or obstructive uropathy; in fact, a considerable number of patients undergo ureteroscopic removal of stone (URS) in the presence of a PCN. We assessed the effectiveness of PCN during URS in the management of upper ureteral stones. We retrospectively analyzed 140 patients who underwent URS for upper ureteral stones between January 2008 and December 2011. All URS were performed by a single experienced surgeon. The subjects were divided into two groups depending on the presence of a PCN at the time of the surgery (PCN group: 42 and non-PCN group: 98). The PCN group was subdivided into two groups depending on the performance of external fluid irrigation through PCN during the surgery (irrigation group: 21 and non-irrigation group: 21). To evaluate operative outcomes, we compared operative times, auxiliary procedures required, and success and complication rates. The PCN group showed significantly better outcomes in terms of the operative time (57.4 minute vs. 68.1 minute) and success rate (92.9% vs. 78.6%) without increasing the complication rate. In the PCN group, the irrigation group showed a shorter operative time compared to the non-irrigation group, although statistical significance was not observed. Other perioperative outcomes, such as the success rate, auxiliary procedures, and complication rates, were not significantly different between the two groups. URS for upper ureteral stones in patients with PCN produced superior surgical outcomes in terms of the success rate, operative time, and auxiliary procedure rate without increasing the complication rate. The presence of PCN with/without external irrigation during URS can be a beneficial factor to produce better outcomes of URS for the management of upper ureteral stones.