Dataset Information

Ureteric stent versus percutaneous nephrostomy for acute ureteral obstruction - clinical outcome and quality of life: a bi-center prospective study.

ABSTRACT:

Background

To compare quality of life (QoL) indices between ureteral stent (DJS) and nephrostomy tube (PCN) inserted in the setting of acute ureteral obstruction.

Methods

Prospective bi-centered study. Over the span of 2?years, 45 DJS and 30 PCN patients were recruited. Quality of life was assessed by 2 questionnaires, EuroQol EQ-5D and 'Tube symptoms' questionnaire, at 2 time points (at discharge after drainage and before definitive treatment).

Results

Patients' demographics and pre-drainage data were similar. There were no clinically significant differences in patient's recovery between the groups, including post procedural pain, defeverence, returning to baseline renal function, and septic shock complications. More DJS patients presented to the emergency room with complaints related to their procedure compared to PCN patients. At first, DJS patients complained more of urinary discomfort while PCN patients had worse symptoms relating to mobility and personal hygiene, with both groups achieving similar overall QoL score. At second time point, PCN patients' symptoms ameliorated while symptoms in the DJS group remained similar, translating to higher overall QoL score in the PCN group.

Conclusions

The two techniques had a distinct and significantly different impact on quality of life. Over time, PCN patients' symptoms relieve and their QoL improve, while DJS patients' symptoms persist. Specific tube related symptoms, and their dynamics over time, should be a major determinant in choosing the appropriate drainage method, especially when definitive treatment is not imminent.

SUBMITTER: Shoshany O

PROVIDER: S-EPMC6712738 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Publications

Ureteric stent versus percutaneous nephrostomy for acute ureteral obstruction - clinical outcome and quality of life: a bi-center prospective study.

Shoshany O O Erlich T T Golan S S Kleinmann N N Baniel J J Rosenzweig B B Eisner A A Mor Y Y Ramon J J Winkler H H Lifshitz D D

BMC urology 20190828 1

<h4>Background</h4>To compare quality of life (QoL) indices between ureteral stent (DJS) and nephrostomy tube (PCN) inserted in the setting of acute ureteral obstruction.<h4>Methods</h4>Prospective bi-centered study. Over the span of 2 years, 45 DJS and 30 PCN patients were recruited. Quality of life was assessed by 2 questionnaires, EuroQol EQ-5D and 'Tube symptoms' questionnaire, at 2 time points (at discharge after drainage and before definitive treatment).<h4>Results</h4>Patients' demographi ...[more]

PMID: 31455309

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Project description:BackgroundUreteral obstruction caused by extrinsic compression is often associated with intra-abdominal cancers. Internal drainage with ureteral stents is typically the first-line therapy to relieve such obstructions. Novel designs of ureteral stents made of different materials have been invented to achieve better drainage. In this study, we described the functional outcomes of a Resonance metallic ureteral stent (Cook Medical, Bloomington, Indiana, USA) in patients with malignant ureteral obstruction and compare the functional duration of Resonance stents with regular polymeric stents in the same cohort.MethodsCancer patients who received polymeric stents and subsequent Resonance stents for ureteral obstruction between July 2009 and November 2012 were included in a chart review. Stent failure was detected by clinical symptoms, imaging studies, and renal function tests. The functional durations of each stent were calculated, and possible factors affecting stent patency were investigated.ResultsA total of 50 stents were successfully inserted into 50 ureteral units in 42 patients with malignant ureteral obstruction. There were 7 antegrade stents and 43 retrograde stents. There were no major complications. Stent-related symptoms were similar in both kinds of stents. After polymeric stents were replaced with Resonance metallic stents, hydronephrosis subsided or remained stable in 90% (45/50) of the ureteral units. Serum creatinine decreased or remained stable in 90% (38/42) of these patients. The Resonance stent exhibited a mean increase in functional duration of 4 months compared with the polymeric stents (p<0.0001), and 50% (25/50) of the Resonance stents exhibited a significant increase in functional duration (more than 3 months). Pre-operative serum creatinine < 2 was associated with a substantial increase in stent duration.ConclusionsResonance stents are effective and safe in relieving malignant ureteral obstructions after polymeric stents failure. Resonance stents can provide a longer functional duration than polymeric stents and should be offered as an option for internal drainage.

Project description:BackgroundThe treatment of impacted upper ureteral stones with hydronephrosis remains a challenge for urologists. The current study aimed to evaluate the impact of preoperative percutaneous nephrostomy (PNS) as a treatment strategy before flexible ureteroscopy (f-URS) of asymptomatic impacted upper ureteral stones with hydronephrosis.MethodsThis multicenter retrospective study included patients who underwent PNS (group A, n=61) and those who did not (group B, n=75) before f-URS for asymptomatic impacted upper ureteral stones with hydronephrosis. Impacted ureteral stones are defined as those that remain in one position for >2 months. Operative outcomes, including stone-free rate, operation time, postoperative hospital days, and complication rate, were evaluated.ResultsThere were no significant differences in age, sex, and stone size between the two groups except in the grade of hydronephrosis, with group A having more cases of advanced hydronephrosis than group B. The stone-free rate was significantly higher in group A than in group B [95% vs. 77% (P=0.004)]. However, there were no significant differences between the groups in operation time [55 vs. 55 min (P=0.84)], postoperative fever [5% vs. 5% (P=1.00)], and postoperative hospital days [2 vs. 2 days (P=0.44)]. In group A, preoperative PNS placement was performed 4 days before f-URS, and the PNS was removed postoperatively on the same day of the f-URS. Additionally, subgroup analysis was performed in cases of grade 2 and 3 hydronephrosis. A total of 110 patients, 60 who underwent f-URS with PNS and 50 who underwent f-URS without PNS, were included. The stone-free rate was significantly higher in f-URS with PNS than in f-URS without PNS [95% vs. 76% (P=0.005)]. However, no significant differences were found between the groups in operation time, ureteral injury, postoperative fever, and postoperative hospital days.ConclusionsAt grade 2 or 3 hydronephrosis, preoperative PNS as a treatment strategy for a few days prior to f-URS for impacted upper ureteral stones improved the stone-free rate without increasing the operation time and postoperative length of hospital stay.

Dataset Information

Ureteric stent versus percutaneous nephrostomy for acute ureteral obstruction - clinical outcome and quality of life: a bi-center prospective study.

Background

Methods

Results

Conclusions

Publications

Ureteric stent versus percutaneous nephrostomy for acute ureteral obstruction - clinical outcome and quality of life: a bi-center prospective study.

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