Percutaneous nephrostomy versus JJ ureteric stent as the initial drainage method in kidney stone patients presenting with acute kidney injury: A prospective randomized study
| Autor: | Amr M. Massoud, Ayman S. Moussa, Ahmed Ragheb, Ahmed Abdelbary, Ahmed Abd El Latif, Rabie M Ibrahim, Hany Fathy, Ahmed M Elbatanouny |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Urology medicine.medical_treatment 030232 urology & nephrology 03 medical and health sciences Kidney Calculi 0302 clinical medicine medicine Ureteroscopy Humans Prospective Studies Ureteric stent Percutaneous nephrolithotomy Hydronephrosis Nephrostomy Percutaneous medicine.diagnostic_test business.industry Acute Kidney Injury medicine.disease Laser lithotripsy Surgery Treatment Outcome Percutaneous nephrostomy 030220 oncology & carcinogenesis Drainage Kidney stones Stents Pyonephrosis business |
| Zdroj: | International journal of urology : official journal of the Japanese Urological AssociationReferences. 27(10) |
| ISSN: | 1442-2042 |
| Popis: | To compare percutaneous nephrostomy tube versus JJ stent as an initial urinary drainage procedure in kidney stone patients presenting with acute kidney injury.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 stones1.5 cm consisted of percutaneous nephrolithotomy for the percutaneous nephrostomy group and ureteroscopic laser lithotripsy for the JJ stent group. For stone size1.5 cm, ureteroscopy or shockwave lithotripsy was carried out for both groups. Percutaneous nephrolithotomy was carried out for renal stones2 cm, and shockwave lithotripsy for stones2 cm. Distal and mid ureteral stones were treated by ureteroscopy.The percutaneous nephrostomy group had shorter operative time (P = 0.001). There was no significant difference in the recovery period for normalization of serum creatinine between both groups (P = 0.120). Procedural failure, ureteric mucosal injury and perforations increased in the case of male sex, stone size1.5 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 size2.5 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).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 stones1.5 cm. |
| Databáze: | OpenAIRE |
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