Comparative Analysis of Ureteral Stent Versus Nephrostomy in Emergency Obstructive Uropathy
Abstract
Qudratullah Wazir*, Sajid Malik, Muhammad Shabbir, Muhammad Ibrahim Khan, Sulaiman Shah and Abdul Nasir
Background: Emergency obstructive uropathy is a true urologic emergency requiring urgent urinary diversion in order to prevent irreversible renal deterioration and systemic complications. The two most common decompressive options are retrograde ureteral stenting and percutaneous nephrostomy, although the best choice in urgent settings has been hotly debated.
Objective: Assess and compare the performance of ureteral stenting with that of percutaneous nephrostomy in emergency obstructive uropathy with regard to clinical efficacy, recovery of renal function, duration of hospitalization, and complications.
Methods: This comparative study was conducted at the Institute of Kidney Diseases, Hayatabad, Peshawar, from February 2024 to February 2025. Eighty adult patients with acute obstructive uropathy requiring immediate decompression were enrolled through non-probability consecutive sampling. They were divided into two groups: ureteral stent placement (n=40) and percutaneous nephrostomy (n=40). Data regarding baseline demographics, the etiology of obstruction, serum creatinine, clinical outcomes, hospital stay, and complications associated with the procedure were gathered. Renal function recovery was calculated by comparing pre- and post-procedure serum creatinine. For the analysis of data, a p-value of ≤ 0.05 was considered significant.
Results: The mean age of patients was 46.8 ± 12.3 years in the ureteral stent group and 48.5 ± 13.1 years in the PCN group, with a predominance of males (67.5%). Ureteric calculi were the most common cause of obstruction (57.5%), followed by malignancy-related obstruction (27.5%). Both procedures caused a significant improvement in renal function. Mean serum creatinine levels decreased from 3.2 ± 1.1 to 1.8 ± 0.6 mg/dL in the stent group and from 3.4 ± 1.3 to 1.6 ± 0.5 mg/dL in the PCN group, with no statistically significant difference between the groups. Urinary decompression was successful in 90% of stent patients and 95% of PCN patients. Hospital stay was shorter in the ureteral stent group (3.6 ± 1.2 days) compared to the PCN group (4.4 ± 1.5 days). The complication rates were similar, though lower urinary tract symptoms were more common in the stent group, and tube-related problems and infection were more common in the PCN group.
Conclusion: Both ureteric stenting and percutaneous nephrostomy are effective and safe procedures for emergency decompression in obstructive uropathy, and have similar rates of recovery of renal function and success of decompression. Ureteric stenting is associated with a shorter hospital stay, while PCN has a slightly higher success rate of decompression.