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Meta-Analysis
. 2021 Mar 23;11(1):6613.
doi: 10.1038/s41598-021-86136-y.

Percutaneous nephrostomy versus retrograde ureteral stenting for acute upper obstructive uropathy: a systematic review and meta-analysis

Ismail Zul Khairul Azwadi  1   2 , Mohd Noor Norhayati  3   2 , Mohd Shafie Abdullah  4   5
Affiliations
Meta-Analysis

Percutaneous nephrostomy versus retrograde ureteral stenting for acute upper obstructive uropathy: a systematic review and meta-analysis

Ismail Zul Khairul Azwadi et al. Sci Rep. .

Abstract

Acute obstructive uropathy is associated with significant morbidity among patients with any condition that leads to urinary tract obstruction. Immediate urinary diversion is necessary to prevent further damage to the kidneys. In many centres, the two main treatment options include percutaneous nephrostomy (PCN) and retrograde ureteral stenting (RUS). The purpose of this study if to compare the efficacy and safety of PCN and RUS for the treatment of acute obstructive uropathy. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL, EMBASE, the World Health Organisation International Clinical Trials Registry Platform and ClinicalTrials.gov. We also searched the reference lists of included studies to identify any additional trials. We included randomised controlled trials and controlled clinical trials comparing the outcomes of clinical improvement (septic parameters), hospitalisation duration, quality of life, urinary-related symptoms, failure rates, post-procedural pain [measured using a visual analogue scale (VAS)] and analgesics use. We conducted statistical analyses using 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 (CIs). 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), or analgesics use. Patients receiving PCN had lower rates of haematuria and dysuria post-operatively and longer hospitalisation duration than those receiving RUS. PCN and RUS are effective for the decompression of an obstructed urinary system, with no significant difference in most outcomes. However, PCN is preferable to RUS because of its reduced impact on the patient's post-operative quality of life due to haematuria and dysuria, although it is associated with slightly longer hospitalisation duration.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Risk of bias graph: review authors’ judgements about each risk of bias item presented as percentages across all included studies.
Figure 3
Figure 3
Risk of bias summary: review authors’ judgements about each risk of bias item for each included study.
Figure 4
Figure 4
Comparison between PCN and RUS for outcome duration to WBC normalisation.
Figure 5
Figure 5
Comparison between PCN and RUS for outcome duration to defervescence.
Figure 6
Figure 6
Comparison between PCN and RUS for outcome hospitalisation duration.
Figure 7
Figure 7
Comparison between PCN and RUS for outcome QoL – mobility.
Figure 8
Figure 8
Comparison between PCN and RUS for outcome QoL – self-care.
Figure 9
Figure 9
Comparison between PCN and RUS for outcome QoL – usual activity.
Figure 10
Figure 10
Comparison between PCN and RUS for outcome QoL – pain/discomfort.
Figure 11
Figure 11
Comparison between PCN and RUS for outcome QoL – anxiety/depression.
Figure 12
Figure 12
Comparison between PCN and RUS for outcome haematuria.
Figure 13
Figure 13
Comparison between PCN and RUS for outcome dysuria.
Figure 14
Figure 14
Comparison between PCN and RUS for outcome frequency.
Figure 15
Figure 15
Comparison between PCN and RUS for outcome urgency.
Figure 16
Figure 16
Comparison between PCN and RUS for outcome failure rate.
Figure 17
Figure 17
Comparison between PCN and RUS for outcome post-procedural pain (as measured by VAS).
Figure 18
Figure 18
Comparison between PCN and RUS for outcome of analgesics use.
See this image and copyright information in PMC

References

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