Publication: Percutaneous nephrostomy versus retrograde ureteral stenting for acute upper obstructive uropathy: A systematic review and meta-analysis
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Date
2022
Authors
Ismail, Zul Khairul Azwadi
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Abstract
Background Acute obstructive uropathy poses significant morbidity among patients with any condition leading to urinary tract obstruction. Immediate urinary diversion is required to prevent further damage to the kidneys. Two main treatment options performed in many centres include percutaneous nephrostomy (PCN) and retrograde ureteral stenting (RUS). Objectives To assess the efficacy of PCN in the treatment of obstructive uropathy in comparison to RUS. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL, EMBASE and the WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov (1 September 2019). We also searched the reference lists of included studies to identify any additional trials. Selection criteria We included randomized controlled trials and controlled clinical trials comparing the outcomes of clinical improvement (septic parameters and duration of hospitalization), quality of life, urinary-related symptoms, failure rates, post-procedural pain (VAS) and use of analgesics. Data collection and analysis We performed statistical analyses using the random-effects models and expressed the results as risk ratio (RR) and risk difference (RD) for dichotomous outcomes and mean difference (MD) for continuous outcomes, with 95% confidence intervals (CI).Results A total of seven trials were identified that included 667 patients. Meta-analysis of the data revealed no difference in the two methods in improvement of septic parameters, quality of life, failure rates, post-procedural pain (VAS) and use of analgesics. Patients receiving PCN experienced lesser rates of haematuria and dysuria after the procedure but with longer duration of hospitalization. Conclusion Both methods are effective in the decompression of an obstructed urinary system with no significant difference in most outcomes. PCN is preferable to RUS because of a lesser impact on patient quality of life after procedure due to haematuria and dysuria although associated with slightly longer duration of hospitalization
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Keywords
percutaneous nephrostomy , retrograde ureteral stenting