Nephrostomy tube versus double J ureteral stent in patients with malignant ureteric obstruction. A systematic review and meta-analysis of comparative studies

Abstract

Purpose: We aimed to perform a systematic review to assess perioperative outcomes, complications, and survival in studies comparing ureteral stent and percutaneous nephrostomy in malignant ureteral obstruction.

Materials and methods: This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Meta-analyses were performed on procedural data; outcomes; complications (device-related, accidental dislodgement, febrile episodes, unplanned device replacement), dislodgment, and overall survival. Continuous variables were pooled using the inverse variance of the mean difference (MD) with a fixed effect, and 95% confidence interval (CI). The incidences of complications were pooled using the Cochran-Mantel-Haenszel method with the random effect model and reported as Odds Ratio (OR), and 95% CI. Statistical significance was set two-tail p-value < 0.05 Results: Ten studies were included. Procedure time (MD -10.26 minutes 95%CI -12.40-8.02, p< 0.00001), hospital stay (MD -1.30 days 95%CI -1.69 - -0.92, p< 0.0001), number of accidental tube dislodgments (OR 0.25 95% CI 0.13 - 0.48, p< 0.0001) were significantly lower in the stent group. No difference was found in mean fluoroscopy time, decrease in creatinine level post procedure, overall number of complications, interval time between the change of tubes, number of febrile episodes after diversion, unplanned device substitution, and overall survival.

Conclusion: Our meta-analysis favors stents as the preferred choice as these are easier to maintain and ureteral stent placement should be recommended whenever feasible. If the malignant obstruction precludes a stent placement, then PCN is a safe alternative.

Keywords: Nephrostomy, Percutaneous; Ureteral Obstruction; Urinary Diversion.

Figure 1. PRISMA flow diagram of the study.

Supplementary Figure 1. Risk of bias in non-randomized controlled trials (ROBINS-I)

Figure 2. Meta-analysis of procedural data. A) procedure time; B) fluoroscopy time; C) interval time between the change of drainage tubes over time

Figure 3. Meta-analysis of outcomes. A) decrease of the creatinine level after the procedure; B) hospital stay; C) overall survival.

Figure 4. Meta-analysis of complications. A) number of febrile episodes after diversion; B) overall number of complications after diversion.

Figure 5. Meta-analysis of complications. A) number of accidental tube dislodgments; B) unplanned device substitution.