Percutaneous nephrostomy versus indwelling ureteral stents in the management of extrinsic ureteral obstruction in advanced malignancies: are there differences?

Abstract

Objectives: To compare the complications and morbidities after placement of a percutaneous nephrostomy (PCN) tube or an internal ureteral stent (IUS) in the management of malignant ureteral obstruction in patients with advanced malignancy.

Methods: A retrospective analysis was performed on a total of 148 patients (80 women and 68 men, mean age 57.3 years, range 20 to 84) with malignant ureteral obstruction, who underwent PCN tube placement (n = 80) or IUS placement (n = 68) between January 2000 and December 2002. The incidence of fever and acute pyelonephritis was expressed as the number of episodes per 100 person-days.

Results: The accumulated incidence of fever and acute pyelonephritis was not different in the two groups. The accumulated incidence and the incidence of febrile episodes in the IUS group was 10.3% and 0.0004/100 person-days; the corresponding values for the PCN group were 15.0% and 0.2154/100 person-days. The incidence of acute pyelonephritis in the IUS and PCN groups was 0.0002/100 person-days and 0.0005/100 person-days, respectively. These patients were treated conservatively and recovered uneventfully. The difference in overall stent-related or catheter-related complications between the IUS and PCN groups was not statistically significant. The accumulated incidence of failed diversion due to obstruction was 11% (8 of 68) and 1.3% (1 of 80) in the IUS and PCN groups, respectively (P = 0.012).

Conclusions: Our results have demonstrated that morbidities after internal or external diversion were minimal in cases of malignant obstruction. However, patients scheduled to receive an IUS should be more carefully monitored for ongoing obstruction than patients scheduled for PCN tube placement.