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Title: COMPARISON OF COMPLICATIONS BETWEEN DOUBLE J STENT AND PERCUTANEOUS NEPHROSTOMY IN OBSTRUCTIVE UROPATHY SECONDARY TO UROLITHIASIS
Authors: Adil Hussain, Syed Saeed Abidi, Ammarah Qazi, Bilal Memon, Faiz Ai, Khawaja Moiz Ullah Ghouri
Journal: The Research of Medical Science Review
| Category | From | To |
|---|---|---|
| Y | 2024-10-01 | 2025-12-31 |
Publisher: Innovative Education Research Institute
Country: Pakistan
Year: 2024
Volume: 2
Issue: 3
Language: English
Keywords: Urolithiasis.CatheterizationDouble J StentPercutaneous ProceduresPostoperative ComplicationsUrinary Tract Obstruction
BACKGROUND: Obstructive uropathy is common and requires immediate treatment to prevent renal damage. Double-J (DJ) stent placement and percutaneous nephrostomy (PCN) are two common treatments for this condition, but they have different complications that may affect patient outcomes and intervention choice. This study compares DJ stent and PCN complication rates in urolithiasis-related obstructive uropathy patients to determine their safety and efficacy.METHODOLOGY: This randomised control trial was conducted at SIUT, Karachi included 296 18-65-year-olds with obstructive uropathy due to urolithiasis and stones larger than 1 cm. Randomisation divided patients into DJ stent (n=148) and PCN (n=148) groups. Prophylactic antibiotics were given to all patients after cystoscopic DJ stent insertion and ultrasound-guided PCNs. Haematuria, procedural failure, fever, trigone irritation, and PCN dislodgement were monitored for 7 days. Statistical analysis compared group complication rates.RESULTS : The mean age was of the patients were 42.10±14.61 year in the DJ stent group and 40.36±13.69 years in the PCN group, with males representing 74.8% and 71.0% of each group, respectively. Procedural failure rates between groups were (3.7% in DJ stent vs 2.8% in PCN, p=0.500). Fever & septicemia documented in 8.4% of the DJ stent group and 4.7% of the PCN group (p=0.269), whereas hematuria was noted in 12.1% of DJ stent patients and 6.5% of PCN patients (p=0.159). Painful trigone irritation was significantly higher in the DJ stent group (15.0% vs. 0%, p=0.0001). PCN-specific complications, such as dislodgement or blockage, were found in 5.6% of the PCN group, with no cases in the DJ Stent group (p=0.015).CONCLUSION: It is to be concluded that both DJ stent and PCN are effective in managing obstructive uropathy secondary to urolithiasis, with similar rates of procedural failure, hematuria, & fever, however, DJ stents are linked with significantly higher rates of painful trigone irritation while PCN shows a unique chance of dislodgement or blockage. These findings recommend that the choice between DJ stent and PCN should consider the distinct complication profiles of each method to optimize the patient outcomes.
To compare the complication rates of Double-J (DJ) stent placement and percutaneous nephrostomy (PCN) in patients with obstructive uropathy secondary to urolithiasis to determine their safety and efficacy.
A randomized control trial was conducted at SIUT, Karachi, involving 296 patients aged 18-65 with obstructive uropathy due to urolithiasis and stones larger than 1 cm. Patients were randomly assigned to either the DJ stent group (n=148) or the PCN group (n=148). Prophylactic antibiotics were administered. Complications monitored for 7 days included haematuria, procedural failure, fever, trigone irritation, and PCN dislodgement. Statistical analysis using the Chi-square test was performed with SPSS version 26.0.
graph TD;
A[Patient Recruitment n=296] --> B[Random Allocation];
B --> C[DJ Stent Group n=148];
B --> D[PCN Group n=148];
C --> E[Prophylactic Antibiotics];
D --> E;
E --> F[Procedure DJ Stent Insertion / PCN];
F --> G[7-Day Monitoring for Complications];
G --> H[Data Collection];
H --> I[Statistical Analysis];
I --> J[Conclusion];
The study confirms that both DJ stents and PCN are effective in managing obstructive uropathy secondary to urolithiasis. DJ stents are associated with a significantly higher incidence of painful trigone irritation, consistent with previous research on lower urinary tract symptoms. PCN, while having fewer irritation-related complications, carries a unique risk of dislodgement or blockage. The choice of intervention should consider these distinct complication profiles to optimize patient outcomes. Limitations include a short follow-up period and non-probability sampling.
Both DJ stent and PCN showed similar rates of procedural failure (3.7% vs. 2.8%), fever & septicemia (8.4% vs. 4.7%), and hematuria (12.1% vs. 6.5%). Painful trigone irritation was significantly higher in the DJ stent group (15.0% vs. 0%, p=0.0001). PCN-specific complications, such as dislodgement or blockage, occurred in 5.6% of the PCN group, with no cases in the DJ stent group (p=0.015). The duration of hospital stay was longer in the DJ stent group (2.74±0.63 days) compared to the PCN group (2.21±0.62 days, p=0.0001).
Both DJ stent and PCN are effective for managing obstructive uropathy due to urolithiasis, with comparable rates of procedural failure, hematuria, and fever. However, DJ stents are linked to significantly higher rates of painful trigone irritation, while PCN has a unique risk of dislodgement or blockage. The selection of either method should be guided by their distinct complication profiles to achieve optimal patient outcomes.
1. Sample Size: The study included a total of 296 patients, with 148 in the DJ stent group and 148 in the PCN group.
2. Painful Trigone Irritation: The DJ stent group experienced a significantly higher rate of painful trigone irritation at 15.0% compared to 0% in the PCN group (p=0.0001).
3. PCN Dislodgement/Blockage: This complication was unique to the PCN group, affecting 5.6% of patients, while no cases were reported in the DJ stent group (p=0.015).
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