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| Percutaneous nephrostomy versus ureteral stent in hydronephrosis secondary to obstructive urolithiasis: A systematic review and meta-analysis |
Andreia Cardosoa,*( ),Aparício Coutinhob,Gonçalo Netob,Sara Anacletoa,Catarina Laranjo Tinocoa,Nuno Moraisa,Mário Cerqueira-Alvesa,Estevão Limab,c,Paulo Motaa,b,c
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aDepartment of Urology, Hospital de Braga, Braga, Portugal
bSchool of Medicine, University of Minho, Braga, Portugal
cAssociation (2CA-Braga). School of Medicine, University of Minho, Braga, Portugal |
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Abstract Objective: To assess if there is a preferable intervention between retrograde ureteral stent (RUS) and percutaneous nephrostomy (PCN) tube, in cases of upper urinary tract stone obstruction with complications requiring urgent drainage, by evaluating outcomes regarding urinary symptoms, quality of life (QoL), spontaneous stone passage, and length of hospital stays, since there is no literature stating the superiority of one modality over the other. Methods: We searched MEDLINE and other sources for relevant articles in June 2019 without any date restrictions or filters applied. The selection was done first by the title and abstract screening and then by full-text assessment for eligibility. Only randomized controlled trials or cohort studies in patients with hydronephrosis secondary to obstructive urolithiasis that presented comparative data between PCN and RUS placement concerning at least one of the defined outcome measures were included. Lastly, MEDLINE database and PubMed platform were screened again using the same terms, from June 2019 until November 2022. Results: Of 556 initial articles, seven were included in this review. Most works were considered of moderate-to-high quality. Three studies regarding QoL showed a tendency against stenting, even though only one demonstrated statistically significant negative impact on overall health state. Two works reported significantly more post-intervention urinary symptoms in stenting patients. One article found that PCN is a significant predictor of spontaneous stone passage, when adjusted for stone size and location. Findings on length of hospital stays were not consistent among articles. Conclusion: PCN appears to be the intervention better tolerated, with less impact on the patient’s perceived QoL and less post-operative urinary symptoms, in comparison with RUS. Nevertheless, further studies with larger samples and a randomized controlled design are suggested.
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Received: 25 March 2022
Available online: 20 April 2024
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Corresponding Authors:
* E-mail address: andreia.filipa.cardoso@hb.min-saude.pt (A. Cardoso).
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Flow chart of study selection.
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| Study | Country | Study design | Case (PCN/RUS), n | Age, year | Gender ratio (M/F), % | BMI, kg/m2 | Urolithiasis background, % | Stone site, % | Number of stones, % | Stone size | | Proximal ureter | Distal ureter | Renal | Single | Multiple | Area, mm2 | Diameter, mm | | de Sousa Morais et al., 2019 [10] | Portugal | Prospective cohort | 50 (18/32) | 57.6a | 50/50 | 27.5a | 70 | 54 | 46 | 0 | 66 | 34 | 66.9b | NA | | Ahmad et al., 2013 [14] | Pakistan | Prospective cohort | 300 (200/100) | 41a | 73/27 | NA | NA | NA | NA | NA | NA | NA | NA | NA | | Goldsmith et al., 2013 [15] | USA | Retrospective cohort | 130 (59/71) | 56b | NA | NA | 58 | 46c | 49c | 28c | 70 | 30 | NA | 8b | | Yoshimura et al., 2005 [16] | Japan | Retrospective cohort | 59 (24/35) | 62.6a | 41/59 | NA | NA | NA | NA | NA | NA | NA | NA | 5.5a | | Mokhmalji et al., 2001 [13] | Germany | Randomized controlled trial | 40 (20/20) | 52a | 53/47 | NA | NA | NA | NA | NA | NA | NA | NA | NA | | Joshi et al., 2001 [9] | UK | Prospective cohort | 34 (13/21) | 55.4a | 65/35 | NA | NA | 62 | 38 | 0 | NA | NA | NA | 9.6a | | Pearle et al., 1998 [17] | USA | Randomized controlled trial | 42 (21/21) | 41.3a | 43/57 | 27.6a | NA | 48 | 52 | 0 | NA | NA | NA | 8.1a |
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Summary of demographic and clinical information of the studies.
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| Study | Intervention, n | EuroQol category (Pre/Post), % | EQ-VAS (Pre/Post) | | Mobility | Self-care | Usual activity | Pain or discomfort | Anxiety or depression | | de Sousa Morais et al., 2019 [10] | PCN, 18 | 27.8/22.2 | 0/0 | 27.8/27.8 | 27.8/22.2 | 44.5/50.0 | 70a/70a | | RUS, 32 | 21.9/37.5 | 6.3/9.4 | 6.3/15.6 | 25/46.9 | 37.6/59.4 | 80a/70a | | Joshi et al., 2001 [9] | PCN, 13 | NA/15 | NA/23 | NA/77 | NA/85 | NA/54 | NA/61b | | RUS, 21 | NA/32 | NA/5 | NA/91 | NA/95 | NA/57 | NA/65b |
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Quality of life assessment with EuroQol-5 Dimension.
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Meta-analysis results. (A) The quality of life assessment with EuroQol-5 Dimension post-intervention; (B) The incidence of post-interventional urinary symptoms; (C) The rate of spontaneous stone passage after PCN and RUS. PCN, percutaneous nephrostomy; RUS, retrograde ureteral stent; CI, confidence interval.
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