Emergent urinary decompression in acute stone-related urinary obstruction: A systematic review and meta-analysis
| Autor: | Cecilia Anabell Galindo-Garza, Sergio Uriel Villegas-De Leon, Eduardo Alberto González-Bonilla, Mauricio Torres-Martinez, Andres Roblesgil-Medrano, David Eugenio Hinojosa-Gonzalez, Cordelia Alanis-Garza, Eduardo Flores-Villalba, Eduardo Barrera-Juárez |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
business.industry Decompression Urology medicine.medical_treatment Urinary system 030232 urology & nephrology Surgery 03 medical and health sciences Urinary obstruction 0302 clinical medicine Percutaneous nephrostomy 030220 oncology & carcinogenesis Meta-analysis medicine Ureteric stent business |
| Zdroj: | Journal of Clinical Urology. 16:19-31 |
| ISSN: | 2051-4166 2051-4158 |
| DOI: | 10.1177/20514158211017027 |
| Popis: | Introduction: Emergent urinary decompression through percutaneous nephrostomy (PCN) or ureteric stent (URS) remains a mainstay in the management of urethral calculi-related obstruction with associated signs of infection or renal injury. Available evidence has shown similar performance, and current guidelines endorse both treatment strategies. Methods: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analysis criteria up until August 2020. Studies included data on stone size and location, operative time, complications, length of stay, analgesic consumption, quality of life (QoL), and clinical outcomes between URS and PCN. Results: Ten studies with a total population of 772, of which 420 were treated with URS and 352 with PCN, were included. No statistical difference in operative time between both techniques was found. Nevertheless, length of stay in PCN was longer than in USR, with a mean difference of −1.87 days ((95% CI −2.69 to −1.06), Z=4.50, p=0.00001). No differences were found in the time to normalization of temperature or white blood cell counts. There were no significant differences in success rates, with an overall odds ratio (OR) of 0.60 ((95% CI 0.26 to −1.40), Z=1.17, p=0.24), or spontaneous passage after emergent drainage between groups. Complication rates ranged from 5% to 25% in URS and from 0% to 38% in PCN. In the studied population, out of the 157 patients from four studies describing complications, only 5% of URS procedures presented complications compared to 2% in PCN, showing a relatively low complication rate for either group (OR=2.07 (95% CI 0.89–4.84), Z=1.68, p=0.09). Differences in QoL were not significant. Conclusion: Both methods are equally effective, with no clear advantage for PCN over URS. Level of evidence: IV |
| Databáze: | OpenAIRE |
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