Abstract
Percutaneous nephrostomy and ureteral stenting are temporary treatments for the upper urinary tract obstruction. The aim of this study was to evaluate the efficacy of these two methods by comparing complications, placement success, urinary symptoms, urine culture analyses prior to derivation placement and derivation removal and success of stone elimination after extracorporeal shock wave lithotripsy (ESWL). This prospective study included 157 patients with supravesical obstruction caused by ureteral stones. Eighty-one patients underwent percutaneus nephrostomy, and JJ stent was inserted in seventy-six (76) patients. After resolving the obstruction, ESWL was performed in all patients. There were no statistically significant differences in success of the urinary derivation placement, the urine culture results before and after placement and success of ESWL treatment between the two studied groups (p>0.05). Urinary symptoms (dysuria, hematuria, urinary urgency, frequent urination during the day) were significantly more present in patients with a JJ stent and this difference was statistically significant for each symptom (p<0.001). Major complications were verified in 2 (2.46%) patients with PCN catheter, and in 7 (9.2%) patients in the group with the JJ stent. Minor complications were significantly more frequent in the group with the JJ stent compared to the group with PCN catheter (28.39% vs 60.52%, p<0.001). Percutaneous nephrostomy and JJ stenting are optimal methods for temporary treatment of supravesical obstruction caused by ureteral stones, with similar incidence of the following complications, except for the pain, which dominates in patients with the JJ stent. Urinary symptoms and asymptomatic bacteriuria are more common in patients with the JJ stent. If the ESWL treatment of ureteral stone is performed after urinary derivation placement, we can expect greater success in patients with the JJ stent. Acta Medica Medianae 2015;54(3):39-44.
Highlights
The most common cause of acute supravesical obstruction or obstruction of the upper urinary tract is stone
percutaneous nephrostomy (PCN) catheter was successfully placed in all 81 patients, and JJ stent in 76/80 (95%) patients
Reposition of ureteral stone with the JJ stent was detected in fifteen patients, but before performing extracorporeal shockwave lithotripsy (ESWL) all stones migrated back to the ureter
Summary
The most common cause of acute supravesical obstruction or obstruction of the upper urinary tract is stone. In cases where an obstruction is associated with persistent pain that does not respond to therapy, high temperature or sepwww.medfak.ni.ac.rs/amm sis and reduced renal function, it requires urgent intervention [1, 2]. It involves drainage of urine which is performed by placement of percutaneous nephrostomy (PCN) catheter or ureteral (JJ) stent with or without repositioning of stone, before making a definitive diagnosis and treatment of obstruction [3, 4]. The choice of the method may vary depending on factors such as the etiology of the obstruction, tendency of physician to a certain method, experience and equipment of the institution. The aim of our study was to evaluate the efficacy of these two methods by analyzing and comparing: complications during and after the placement of PCN catheter and JJ stent, placement success, regression of hydronephrotic changes after placement, urinary symptoms, urine culture prior to Percutaneous nephrostomy and double pigtail (JJ) ureteral stents
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