| Autor: |
Moon YJ; Department of Medicine, Graduate School, Yonsei University, Seoul 03722, Republic of Korea., Jun DY; Department of Urology, Severance Hospital, Urological Science Institute, College of Medicine, Yonsei University, Seoul 03722, Republic of Korea., Jeong JY; Department of Urology, National Health Insurance Service Ilsan Hospital, Goyang 10444, Republic of Korea., Cho S; Department of Urology, Inje University Ilsan Paik Hospital, College of Medicine, Inje University, Goyang 10380, Republic of Korea., Lee JY; Department of Urology, Severance Hospital, Urological Science Institute, College of Medicine, Yonsei University, Seoul 03722, Republic of Korea.; Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul 03722, Republic of Korea., Jung HD; Department of Urology, Inje University Ilsan Paik Hospital, College of Medicine, Inje University, Goyang 10380, Republic of Korea. |
| Abstrakt: |
Background and Objectives : The European Association of Urology guidelines on urolithiasis highlight the limited evidence supporting the superiority of percutaneous nephrostomy (PCN) over retrograde ureteral stent placement for the primary treatment of infected hydronephrosis secondary to urolithiasis. We, therefore, conducted a systematic review and meta-analysis comparing the effects of PCN and retrograde ureteral stent in patients with severe urinary tract infections secondary to obstructive urolithiasis. Materials and Methods : Meta-analyses were performed to compare four outcomes: time for the temperature to return to normal; time for the white blood cell (WBC) count to return to normal; hospital length of stay; and procedure success rate. After a full-text review, eight studies were identified as relevant and included in our systematic review and meta-analysis. Results : No significant difference was detected between PCN and retrograde ureteral stenting for the time for the temperature to return to normal ( p = 0.13; mean difference [MD] = -0.74; 95% confidence interval [CI] = -1.69, 0.21; I 2 = 96%) or the time for the WBC count to return to normal ( p = 0.24; MD = 0.46; 95% CI = -0.30, 1.21; I 2 = 85%). There was also no significant difference between methods for hospital length of stay ( p = 0.78; MD = 0.45; 95% CI = -2.78, 3.68; I 2 = 96%) or procedure success rate ( p = 0.76; odds ratio = 0.86; 95% CI = 0.34, 2.20; I 2 = 47%). Conclusions : The clinical outcomes related to efficacy did not differ between PCN and retrograde ureteral stenting for severe urinary tract infection with obstructive urolithiasis. Thus, the choice between procedures depends mainly on the urologist's or patient's preferences. |
