Is Double J Stenting or Percutaneous Nephrostomy More Suitable for Maximizing the Clinical Effects of Temporary Urinary Diversion for Acute Pyelonephritis with a Complicated Ureteral Stone?

Jeonghyouk Choi; Taesoo Choi; Dong-Gi Lee; Gyeong Eun Min; Hyung Lae Lee; Koo Han Yoo

doi:10.14777/uti.2019.14.3.87

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Choi, Choi, Lee, Min, Lee, and Yoo: Is Double J Stenting or Percutaneous Nephrostomy More Suitable for Maximizing the Clinical Effects of Temporary Urinary Diversion for Acute Pyelonephritis with a Complicated Ureteral Stone?

Original Article

Urogenit Tract Infect 2019;14(3):87-92.

Published online: 20 January 2019

DOI: https://doi.org/10.14777/uti.2019.14.3.87

Is Double J Stenting or Percutaneous Nephrostomy More Suitable for Maximizing the Clinical Effects of Temporary Urinary Diversion for Acute Pyelonephritis with a Complicated Ureteral Stone?

Jeonghyouk Choi, Taesoo Choi, Dong-Gi Lee, Gyeong Eun Min, Hyung Lae Lee, Koo Han Yoo

Department of Urology, School of Medicine, Kyung Hee University, Seoul, Korea

Correspondence to: Koo Han Yoo https://orcid.org/0000-0001-7952-7902 Department of Urology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Korea Tel: +82-2-440-6271, Fax: +82-2-440-7744 E-mail: yookoohan@khu.ac.kr

Received 18 September 2019 Revised 25 October 2019 Accepted 14 November 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study compared the clinical benefits of double J (DJ) ureteral stenting with percutaneous nephrostomy (PCN) for the management of acute pyelonephritis (APN) with complicated ureteral stones.

Materials and Methods

The records of 85 patients with complicated APN between December 2006 and July 2017 were reviewed retrospectively. Sixty one patients who underwent DJ or PCN for the management of acute urinary obstruction were enrolled in this study. Some of the participants were excluded for concurrent renal stones, multiple ureteral stones, ureteral stricture, malignancy, and anatomical anomalies. The patient and stone characteristics and peri-procedural laboratory test results of the groups were compared. The success rate, depending on the type of urinary diversion and the presence of immediate complications, were also analyzed.

Results

In this study, 19 patients underwent DJ stenting, and 42 patients underwent PCN as a transient urinary diversion. No failed procedures or immediate complications requiring subsequent intervention were encountered (Clavien–Dindo grade II-V). Urologists preferred PCN to DJ stenting in cases with an elevated serum creatinine level (p=0.001) and higher C-reactive protein (CRP) level (p＜0.001). The indicative parameters for renal injury and septic conditions (white blood cell count, segment neutrophil, and creatinine levels) tended to show immediate improvement, whereas CRP did not; however, the differences in markers were not significant (p=0.701, 0.962, 0.288, and 0.360, respectively).

Conclusions

Both DJ stenting and PCN were safe and feasible methods for the management of complicated APN. With experienced urologists or radiologists, there may be little danger of prolonged renal failure or other procedure-related complications.

Keywords: Nephrostomy, percutaneous, Urinary diversion, Pyelonephritis, Ureterolithiasis, Ureteral obstruction

References

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Table 1.

Comparative characteristics of the patients according to the type of urinary diversion

Characteristic	Double J stent (n=19)	Percutaneous nephrostomy (n=42)	p-value
Age (y)	56.8 (24–86)	60.3 (21–92)	0.443
Sex			0.737
Male (n=13)	3 (23.1)	10 (76.9)
Female (n=48)	16 (33.3)	32 (66.7)
Underlying disease
Diabetes mellitus	2 (10.5)	12 (28.6)	0.992
Hypertension	10 (52.6)	20 (47.6)	0.180
Ischemic heart disease	0 (0)	1 (2.4)	0.530
Cerebrovascular disease	4 (21.1)	5 (11.9)	0.415
Medical history (Hx.)
Stone Hx.	3 (15.8)	14 (33.3)	0.961
Urinary tract infection Hx.	4 (21.1)	7 (16.7)	0.856
Stone
Size (mm)	9.3 (3–23)	8.9 (1.1–28)	0.802
Proximal/mid/distal	12 (63.2)/1 (5.3)/6 (31.6)	27 (64.3)/4 (9.5)/11 (26.2)	–
Culture
Positive urine culture	9 (47.4)	28 (66.7)	0.153
Bacteremia	4 (21.1)	19 (45.2)	0.091
Failure	0 (0)	0 (0)	–
Mortality	0 (0)	0 (0)	–
Initial laboratory data
White blood cell (×10³/l)	1.28 (0.68–2.20)	1.21 (0.18–2.99)	0.604
Segment neutrophil (%)	78.1 (55.0–95.9)	82.3 (35.3–94.4)	0.277
Hemoglobin (g/dl)	12.3 (8.5–13.9)	12.0 (9.4–16)	0.040^∗
Hematocrit (%)	37.0 (27.1–41.0)	35.7 (27.5–45.2)	0.015^∗
Platelet count (×10³/l)	249 (70–458)	201 (39–505)	0.007^∗
Blood urea nitrogen (mg/dl)	16.4 (8–30)	19.2 (9–50)	0.092
Creatinine (mg/dl)	0.88 (0.48–1.30)	1.29 (0.32–3.70)	0.001^∗
Erythrocyte sedimentation rate (mm/hr)	38.0 (6–85)	54.0 (2–108)	0.099
C-reactive protein (mg/dl)	4.40 (0.2–16.5)	11.83 (0.02–33.3)	＜0.001^∗
Albumin (g/dl)	4.12 (2.9–4.9)	3.87 (2.5–4.8)	0.081
Aspartate transaminase (U/L)	27.9 (17–74)	29.6 (12–163)	0.786
Alanine transaminase (U/L)	27.3 (11–118)	21.5 (4–97)	0.301
Na (mEq/L)	136.7 (130–141)	136.5 (124–143)	0.875
K (mEq/L)	3.80 (3.1–4.2)	3.73 (2.4–4.7)	0.472

Values are presented as mean (range) or number (%).

Hx.: history.

^∗p＜0.05, statistically significant.

Table 2.

Periprocedural laboratory parameters indicative of sepsis and septic shock

	Double J stent (n=19)	Percutaneous nephrostomy (n=42)	p-value
Subsequent data after procedure
WBC (×10³/l)	1.05 (0.67–1.87)	1.11 (0.32–2.96)	0.817
Segment neutrophil (%)	74.8 (40.4–93.8)	76.1 (40.5–97.0)	0.829
Cr (mg/dl)	0.85 (0.27–1.40)	0.94 (0.48–1.50)	0.436
CRP (mg/dl)	10.49 (1.2–28.7)	9.70 (0.1–23.5)	0.810
Changes in laboratory values
WBC (×10³/l)	–0.26 (−1.01–0.53)	–0.14 (−2.05–2.66)	0.701
Segment neutrophil (%)	–4.3 (−24.5–10.9)	–4.6 (−36.4–50.5)	0.962
Cr (mg/dl)	–0.1 (−0.5–0.2)	–0.3 (−2.1–0.5)	0.288
CRP (mg/dl)	6.08 (−4.20–26.23)	2.51 (−12.15–21.45)	0.360

Values are presented as mean (range).

WBC: white blood cell, Cr: creatinine, CRP: C-reactive protein.

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