Percutaneous nephrostomy versus JJ ureteric stent as the initial drainage method in kidney stone patients presenting with acute kidney injury: A prospective randomized study

• Published in: International journal of urology 2020-10, Vol.27 (10), p.916-921
• Main Authors: Elbatanouny, Ahmed M, Ragheb, Ahmed M, Abdelbary, Ahmed M, Fathy, Hany, Massoud, Amr M, Abd El Latif, Ahmed, Moussa, Ayman S, Ibrahim, Rabie M
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - etiology; Acute Kidney Injury - therapy; calcular acute kidney injury; calcular anuria; Calculi; Creatinine; Dialysis; Drainage; Fever; Fluoroscopy; Humans; Implants; JJ ureteric stent and upper urinary tract stones; Kidney Calculi - complications; Kidney Calculi - diagnostic imaging; Kidney Calculi - surgery; Kidney stones; Kidneys; Lithotripsy; Male; Mucosa; Nephrolithiasis; Nephrostomy, Percutaneous - adverse effects; Pain; percutaneous nephrostomy; Pregnancy complications; Prospective Studies; Stents - adverse effects; Surgical drains; Treatment Outcome; Ureter; Ureteral stents; Ureteroscopy - adverse effects; Urinary tract; Urogenital system; Wound drainage
• ISSN: 0919-8172; 1442-2042
• DOI: 10.1111/iju.14331

Objective To compare percutaneous nephrostomy tube versus JJ stent as an initial urinary drainage procedure in kidney stone patients presenting with acute kidney injury. Methods Between January 2017 and January 2019, 143 patients with acute kidney injury secondary to obstructive kidney stone were prospectively randomized into the percutaneous nephrostomy tube group (71 patients) and JJ stent group (72 patients) at Beni‐Suef University Hospital, Beni‐Suef, Egypt. Exclusion criteria included candidates for acute dialysis, fever (>38°C), pyonephrosis, pregnancy and uncontrolled coagulopathy. The period required for serum creatinine normalization, failure of insertion, operative and fluoroscopy time were recorded. Definitive stone management for proximal ureteral stones >1.5 cm consisted of percutaneous nephrolithotomy for the percutaneous nephrostomy group and ureteroscopic laser lithotripsy for the JJ stent group. For stone size 2 cm, and shockwave lithotripsy for stones 1.5 cm and upper ureteric stones in the JJ stent group. Procedural failure, pelvic perforations and intraoperative bleeding increased in case of male sex, mild hydronephrosis and stone size >2.5 cm in the percutaneous nephrostomy group. Suprapubic pain, urethral pain and lower urinary tract symptoms were significant in the JJ stent group. The presence of a JJ stent directed us toward ureteroscopy (P = 0.002) and the presence of a percutaneous nephrostomy directed us toward percutaneous nephrolithotomy (P = 0.001). Conclusions Percutaneous nephrostomy facilitates subsequent percutaneous nephrolithotomy, especially when carried out by a urologist, and it has a higher insertion success rate, a shorter operative time and a lesser incidence of postoperative urinary tract infection than a JJ stent. A JJ stent facilitates subsequent ureteroscopy, but operative complications can increase in the case of proximal ureteral stones >1.5 cm.