Percutaneous Nephrostomy versus Ureteral Stent for Severe Urinary Tract Infection with Obstructive Urolithiasis: A Systematic Review and Meta-Analysis

• Published in: Medicina (Kaunas, Lithuania) Vol. 60; no. 6; p. 861
• Main Authors: Moon, Young Joon, Jun, Dae Young, Jeong, Jae Yong, Cho, Seok, Lee, Joo Yong, Jung, Hae Do
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 24.05.2024; MDPI
• Subjects: Bias; Calculi, Urinary; Humans; Hydronephrosis; Length of stay; Length of Stay - statistics & numerical data; Male; Meta-analysis; Mortality; Nephrostomy, Percutaneous - methods; Patients; percutaneous nephrostomy; Performance evaluation; Research methodology; stent; Stent (Surgery); Stents - adverse effects; Success; Systematic review; Treatment Outcome; ureteral obstruction; Urinary tract diseases; Urinary Tract Infections; Urogenital system; Urolithiasis - complications; Urolithiasis - surgery; Urology; South Korea; United States > US; stent; percutaneous nephrostomy; ureteral obstruction
• ISSN: 1648-9144; 1010-660X; 1648-9144
• DOI: 10.3390/medicina60060861

: The European Association of Urology guidelines on urolithiasis highlight the limited evidence supporting the superiority of percutaneous nephrostomy (PCN) over retrograde ureteral stent placement for the primary treatment of infected hydronephrosis secondary to urolithiasis. We, therefore, conducted a systematic review and meta-analysis comparing the effects of PCN and retrograde ureteral stent in patients with severe urinary tract infections secondary to obstructive urolithiasis. : Meta-analyses were performed to compare four outcomes: time for the temperature to return to normal; time for the white blood cell (WBC) count to return to normal; hospital length of stay; and procedure success rate. After a full-text review, eight studies were identified as relevant and included in our systematic review and meta-analysis. : No significant difference was detected between PCN and retrograde ureteral stenting for the time for the temperature to return to normal ( = 0.13; mean difference [MD] = -0.74; 95% confidence interval [CI] = -1.69, 0.21; I = 96%) or the time for the WBC count to return to normal ( = 0.24; MD = 0.46; 95% CI = -0.30, 1.21; I = 85%). There was also no significant difference between methods for hospital length of stay ( = 0.78; MD = 0.45; 95% CI = -2.78, 3.68; I = 96%) or procedure success rate ( = 0.76; odds ratio = 0.86; 95% CI = 0.34, 2.20; I = 47%). : The clinical outcomes related to efficacy did not differ between PCN and retrograde ureteral stenting for severe urinary tract infection with obstructive urolithiasis. Thus, the choice between procedures depends mainly on the urologist's or patient's preferences.