Percutaneous nephrostomy versus ureteral stent in hydronephrosis secondary to obstructive urolithiasis:A systematic review and meta-analysis

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.

Use of percutaneous nephrostomy and ureteral stenting in management of ureteral obstruction

The management options for ureteral obstruction are diverse, including retrograde ureteral stent insertion or antegrade nephrostomy placement, with or without eventual antegrade stent insertion. There is currently no consensus on the ideal treatment or treatment pathway for ureteral obstruction owing, in part, to the varied etiologies of obstruction and diversity of institutional practices. Additionally, different clinicians such as internists, urologists, oncologists and radiologists are often involved in the care of patients with ureteral obstruction and may have differing opinions concerning the best management strategy. The purpose of this manuscript was to review available literature that compares percutaneous nephrostomy placement vs ureteral stenting in the management of ureteral obstruction from both benign and malignant etiologies.

Clinical Application of Percutaneous Nephrostomy in Some Urologic Diseases

Percutaneous nephrostomy was applied in some other urologic diseases and the efficacy was evaluated. Percutaneous nephrostomy for percutaneous nephrolithotomy （PNL） was performed in patients with various renal, perinephric and bladder diseases （n=79）. The tract establishment, operation duration and complications were observed and the efficacy was assessed. The results showed that the tracts were successfully established in 79 cases. The operation lasted 4–20 min. 12F–16F single tract was established in nephrohydrop patients and 16F–20F single or multiple tracts were established in patients with pyonephrosis, renal cortical abscess, renal cyst and perinephric abscess. During dilation, no leakage of liquor puris was noted. Establishment of 18F single tract was achieved in one urinoma patient. In two patients with foreign body in kidney, the foreign bodies were removed via established 14F single tract. 18F tracts were established in 2 patients with bladder contracture, which was followed by the placement of 16F balloon urethral catheter for drainage. No complications, such as massive bleeding, intestinal injury and spreading of infection took place in our series. All the patients were followed up for 2–12 months. No long-term complications such as dropping of drainage tube occurred. It is concluded that as a minimally invasive technique, percutaneous nephrostomy has the advantages of convenience, simplicity and causing less complications and can be used for various urologic diseases.

Laparoscopic ureterolysis with simultaneous ureteroscopy and percutaneous nephroscopy for treating complex ureteral obstruction after failed endoscopic intervention:A technical report

Objective:Complex ureteral obstruction is refractory to conventional urological intervention.This report describes a case of laparoscopic ureterolysis with simultaneous ureteroscopy and percutaneous nephroscopy for treating complex ureteral obstruction.Methods:Right-side multiple ureteral stones and complicating ureteral obstruction failed an initial attempt of ureteroscopy lithotripsy with simultaneous percutaneous nephroscopy in a 23-year-old male.Laparoscopic ureterolysis with ureteroscopy and percutaneous nephroscopy was used simultaneously to dissect the periureteral adhesions with the patient placed in the Galdakao-modified supine Valdivia position.The ureter was incised to allow the insertion of a ureteral catheter through the twisted ureter,and a guide wire was advanced into the pelvis using ureteroscopy.A double-J stent was placed into the right-side ureter using antegrade percutaneous nephroscopy.Results:The laparoendoscopic procedure lasted 330 min with an estimated bleeding volume of 100 mL.The patient underwent an uneventful postoperative course,and postoperative followup radiography confirmed good positioning of the double-J stent.The double-J stent was removed 3 months after operation.The patient remained asymptomatic within a 13-month follow-up period.Conclusion:Laparoscopic ureterolysis with simultaneous ureteroscopy and percutaneous nephroscopy is an effective and safe treatment option for complex ureteral obstruction.

Acute kidney injury due to bilateral malignant ureteral obstruction:Is there an optimal mode of drainage?

There is a well-known relationship between malignancy and impairment of kidney functions,either in the form of acute kidney injury or chronic kidney disease.In the former,however,bilateral malignant ureteral obstruction is a surgically correctable factor of this complex pathology.It warrants urgent drainage of the kidneys in emergency settings.However,there are multiple controversies and debates about the optimal mode of drainage of the bilaterally obstructed kidneys in these patients.This review addressed most of the concerns and provided a comprehensive presentation of this topic from the recent literature.Also,we provided different perspectives on the management of the bilateral obstructed kidneys due to malignancy.Despite the frequent trials for improving the success rates and functions of ureteral stents,placement of a percutaneous nephrostomy tube remains the most recommended tool of drainage due to bilateral ureteral obstruction,especially in patients with advanced malignancy.However,the disturbance of the quality of life of those patients remains a major unresolved concern.Beside the unfavorable prognostic potential of the underlying malignancy and the various risk stratification models that have been proposed,the response of the kidney to initial drainage can be anticipated and evaluated by multiple renal prognostic factors,including increased urine output,serum creatinine trajectory,and time-to-nadir serum creatinine after drainage.

Estimation of successful capping with complete aspiration of bladder via nephroureterostomy tube

BACKGROUND Ureteral stent and nephroureterostomy tube(NUT)are treatments of ureteral obstruction.Ureteral stent provides better quality of life.Internalization of NUT is desired whenever possible.AIM To assess outcomes of capping trial among cancer patients with complete aspiration of retained contrast from bladder via NUT.METHODS Our Institutional Review Board approved retrospective review of all NUT placement,NUT exchange and conversion of nephrostomy catheter into NUT performed during June 2013 to June 2015(n=578).Cases were excluded due to lack of imaging of bladder(n=37),incomplete aspiration of bladder(n=324),no attempt at capping NUT(n=166),and patients with confounding factors interfering with results of capping trial including non-compliant bladder,bladder outlet obstruction and catheter malposition(n=14).Study group consisted of 37 procedures in 34 patients(male 19,female 15,age 2-83 years,average 58,median 61)most with cancer(prostate 8,endometrial 5,bladder 4,colorectal 4,breast 2,gastric 2,neuroblastoma 2,cervical 1,ovarian 1,renal 1,sarcoma 1,urothelial 1 and testicular 1)and one with Crohn’s disease.Medical records were reviewed to assess outcomes of capping trial.Exact 95%confidence intervals(95%CI)were calculated.RESULTS Among patients with complete aspiration of retained contrast,30(81%,95%CI:0.65-0.92)catheters were successfully capped(range 12-94 d,average 40,median 24.5)until planned conversion to internal stent(23),routine exchange(5),removal(1)or death unrelated to catheter(1).Seven capping trials(19%,95%CI:0.08-0.35)were unsuccessful(range 2-22 d,average 12,median 10)due to leakage(3),elevated creatinine(2),fever/hematuria(1)and nausea/vomiting(1).CONCLUSION Capping trial success among patients with complete aspiration of retained contrast/urine from bladder via NUT appears high.

Purple urine bag syndrome:An unusual manifestation of urinary tract infection,our experience at a tertiary care center

Background:Purple urine bag syndrome(PUBS)is an unusualconditionin which a purple discoloration of urine and bag occurs in people with urinary catheters.People with purple urine usually do not complain of any symptoms.The purple discoloration of the urine bag is often the only finding,frequently noted by caregivers.Materials and methods:This prospective observational study was conducted at our tertiary care institute from June 2018 to May 2020.A total of 46 patients with PUBS wereincluded in this study.The objective of our study was to record the prevalence of each predisposing factor and to correlate the pathological mechanism through which the PUBS is manifested.Results:The mean age of PUBS patients was 67.4years and 67.4%were males.Most patients of PUBS(60.9%)had a urethral catheter,while there was percutaneous nephrostomy in 26.1%patients and 13%patients had a percutaneous suprapubic cystostomy catheter.Among the patients,69.65%were bedridden orin an institutionalized situation,73.9%were suffering from chronic constipation,21.7%were associated with dementia,and 47.8%were cerebrovascular accidents with hemiparesis patients.In addition,93.5%of patients presented with alkaline urine and 3 patients with acidic urine.The most common bacteria isolated in urine culture were E coli and Pseudomonas.Conclusions:Urinary catheter associated urinary tract infection and PUBS is most commonly documented in females,but our study showed that it is more common in males.The appearance of a purple bag does not depend on the material and type of the catheter or the catheterization method.In addition,no correlation was found between the microorganisms isolated from the environment and patients'urine.

Predictors of time-to-nadir serum creatinine after drainage of bilaterally obstructed kidneys due to bladder cancer

Background:There are persistent controversies about the outcomes and benefits of drainage of malignant ureteral obstruction by percutaneous nephrostomy(PCN).This study aimed to assess the predictors of the time-to-nadir(TTN)of serum creatinine(SCr)levels after drainage of bilaterally obstructed kidneys(BOKs)due to bladder cancer(BC)by PCN.Materials and methods:This prospective nonrandomized study included patients with BOKs due to BC treated by PCN between April 2019 and March 2022.The primary outcome measure was TTN.Results:Of the 55 patients with a median age(range)of 66 years(47-86 years),32(58.2%)had a normal nadir SCr and 23(41.8%)had a high nadir SCr within 21 days after drainage of BOKs due to BC.High nadir SCr was associated with a higher mean age(p=0.011)and lower body mass index(BMI,p=0.043).However,patients with normal nadir SCr had a significantly shorter TTN(p=0.023)and an increased mean SCr trajectory(p<0.001)during TTN.In multivariate analysis,low urine output at presentation(p=0.021)and high BMI(p=0.006)were associated with longer TTN.However,the mean parenchymal thickness(p=0.428)and laterality of drainage(p=0.466)were not associated with the mean TTN and SCr normalization rates.According to the modified Clavien-Dindo classification,8 cases of hematuria were managed conservatively(grade 2),and 2 cases of PCN slippage were repositioned using local anesthesia(grade 3).Conclusions:Despite the safety of PCN for drainage of BOKs due to BC,more than 41%of the patients failed to have a normal nadir SCr.Predrainage low urine output and high BMI were associated with longer TTN.Laterality of drainage had no significant effects on the TTN and SCr trajectory.