Percutaneous nephrostomy or double J stenting, which is better modality for obstructive uropathy-a descriptive study

Authors

  • Vinamra Mittal Department of General Surgery, Himalayan Institute and Hospital Trust University, Swami Rama Nagar, Doiwala, Dehradun, Uttarakhand
  • Manoj Biswas Department of General Surgery, Himalayan Institute and Hospital Trust University, Swami Rama Nagar, Doiwala, Dehradun, Uttarakhand
  • Shobha Lal Department of General Surgery, Himalayan Institute and Hospital Trust University, Swami Rama Nagar, Doiwala, Dehradun, Uttarakhand

DOI:

https://doi.org/10.18203/2320-6012.ijrms20162317

Keywords:

Nephrostomy, Percutaneous, Ureter, Stents, Hydronephrosis, Urinary calculi, Renal failure, Acute renal failure

Abstract

Background: Percutaneous Nephrostomy or Ureteric Stenting is indicated in patients with Acute Renal Failure following urinary tract obstruction. The purpose of this study was to evaluate the better treatment modality in terms of S. Creatinine level.  

Methods: Total 50 patients with Creatinine level of >2 mg/dl and hydronephrosis due to upper urinary tract obstruction were grouped into either percutaneous nephrostomy or stent insertion groups. These patients were then evaluated by overall trend of S. creatinine and urine output levels postoperatively.

Results: Two comparable groups of PCN and DJS were formed with a mean age of 45.5 years and 47.9 years. Male to female ratio was 1.5:1 and 1.2:1 respectively. Pain with oliguria or anuria was the major presentation. The urine output levels showed a sudden increase postoperatively with a subsequent trend towards normal value in both the groups. Creatinine however showed a normalizing trend from a mean 6.46 mg/dl preoperatively to 1.01mg/dl postoperatively in PCN group whereas in DJS group 5.38mg/dl preoperatively to 2.75mg/dl with a rising trend from POD 15 requiring conversion to PCN in 20% of patients with subsequent normalization of creatinine levels to 0.95 mg/dl. Statistically we found no difference in the outcome when both the groups were compared in view of serum creatinine and urine output levels whereas there is a significant difference in the pre and post operative outcome of both the groups.  

Conclusions: Our results thus support that though there is no significant difference among both the procedures, ureteral stents are associated with intolerable lower urinary tract symptoms owing to conversion to secondary percutaneous Nephrostomy. Hence percutaneous nephrostomy is superior to ureteral stents for diversion of urine in patients with ARF due to obstructive uropathy.

 

References

Liano F, Pascual J. Epidemiology of acute renal failure: A prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group. Kidney Int. 1996;50:811-8.

Danilovic A, Ioannis M. Antonopoulos. Likelihood of Retrograde Double J Stenting according to ureteral obstructing pathology. International Braz J Urol. 2005;31(5):431-6.

Mokhmalji H, Braun PM, Martinez Portillo FJ. Percutaneous nephrostomy versus ureteral stents for diversion of hydronephrosis caused by stones: A prospective, randomized clinical trial. J Urol. 2001;166:1088-92.

Fasano JM, Khan SR. Intratubular crystallization of calcium oxalate in the presence of membrane vesicles: An in vitro study. Kidney Int. 2001;59:169-78.

Wei B, Xu Z, Ruan J, Zhu M, Hu Q, Wang Q, et al. Experience with the Diagnosis and Management of Symptomatic Ureteric Stones During Pregnancy. Urology 2012;79:508-12.

Tazi K. Percutaneous nephrostomy: indications, techniques and results. Retrospective study of 81 cases: Ann Urol (Paris). 2000;34(6):391-7.

Yagci C, Ustuner E, Atman ED, Baltaci S, Uzun C, Akyar S. Diuretic agent and normal saline infusion technique for ultrasound-guided percutaneous nephrostomies in nondilated pelvicaliceal systems. Cardiovasc Intervent Radiol. 2013;36(2):492-7.

Van Glabecke E, Conort P, Chartier-Kastler E. Treatment of complicated renal colic in patients treated with indinavir: value of double J stents. Prog Urol. 1999;9:470-7.

Fowler JE Jr., Meares EM, Goldin AR. Percutaneous nephrostomy: techniques, indications, and results. Urology. 1975;6:428-32.

Stables DP. Percutaneous nephrostomy: techniques, indications, and results. Urol Clin North Am. 1982;9:15-9.

Nariculam A. Nephrostomy insertion for patients with bilateral ureteric obstruction caused by prostate cancer: The British Journal of Radiology. 2009;82:571-6.

Hussain M, Lal M, Ali B, Ahmed S, Zafar N, Naqvi SA, et al. Management of urinary calculi associated with renal failure: Pak Med Assoc. 1995;45(8):205-8.

Fournier G. Percutaneous drainiage nephrostomy in patients over 70 years of age. Apropos of 98 nephrostomies in 74 patients: Prog Urol. 1994;4(3):362-70.

Abber JC, Kahn RI. Pyelonephritis from severe incrustations on silicone ureteral stents: management. J Urol. 1983;130:763-71.

Pollard SG, Macfarlane R. Symptoms arising from Double-J ureteral stents. J Urol. 1988;139:37-41.

Bregg K, Riehle RA. Morbidity associated with indwelling internal ureteral stents after shock wave lithotripsy. J Urol. 1989;141:510-15.

Pryor JL, Langley MJ, Jenkins AD. Comparison of symptom characteristics of indwelling ureteral catheters. J Urol. 1991;145:719-23.

Mardis HK, Kroeger RM. Ureteral stents. Materials. Urol Clin North Am. 1988;15:471-75.

Mays NB, Petruckevitch A, Snowdon C. Patients’ quality of life following extracorporeal shock-wave lithotripsy and percutaneous nephrolithotomy for renal calculi. Int J Technol Assess Health Care. 1990; 6: 633-37.

Joshi HB, Adams S, Obadeyi OO, Rao PN. Nephrostomy tube or “JJ” ureteric stent in ureteric obstruction: assessment of patient perspectives using quality-of-life survey and utility analysis. Eur Urol. 2001;39:695-701.

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Published

2017-01-04

How to Cite

Mittal, V., Biswas, M., & Lal, S. (2017). Percutaneous nephrostomy or double J stenting, which is better modality for obstructive uropathy-a descriptive study. International Journal of Research in Medical Sciences, 4(8), 3486–3491. https://doi.org/10.18203/2320-6012.ijrms20162317

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Original Research Articles