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Research Article
Percutaneous Nephrostomy Versus Retrograde Ureteral Stenting for Acute Obstructive Uropathy: A Systematic Review and Meta-Analysis
MOHD SHAFIE ABDULLAH
Universiti Sains Malaysia
Corresponding Author
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Acute obstructive uropathy is associated with significant morbidity among patients with any condition that leads to urinary tract obstruction. Immediate urinary diversion is necessary to prevent further damage to the kidneys. In many centres, the two main treatment options include percutaneous nephrostomy (PCN) and retrograde ureteral stenting (RUS). The purpose of this study if to compare the efficacy and safety of PCN and RUS for the treatment of acute obstructive uropathy.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL, EMBASE, the World Health Organisation International Clinical Trials Registry Platform and ClinicalTrials.gov. We also searched the reference lists of included studies to identify any additional trials. We included randomised controlled trials and controlled clinical trials comparing the outcomes of clinical improvement (septic parameters and hospitalisation duration), quality of life, urinary-related symptoms, failure rates, post-procedural pain [measured using a visual analogue scale (VAS)] and analgesics use. We conducted statistical analyses using random effects models and expressed the results as risk ratio (RR) and risk difference (RD) for dichotomous outcomes and mean difference (MD) for continuous outcomes, with 95% confidence intervals (CIs).
Seven trials were identified that included 667 patients. Meta-analysis of the data revealed no difference in the two methods in improvement of septic parameters, quality of life, failure rates, post-procedural pain (VAS), or analgesics use. Patients receiving PCN had lower rates of haematuria and dysuria post-operatively and longer hospitalisation duration than those receiving RUS. PCN and RUS are effective for the decompression of an obstructed urinary system, with no significant difference in most outcomes. However, PCN is preferable to RUS because of its reduced impact on the patient’s post-operative quality of life due to haematuria and dysuria, although it is associated with slightly longer hospitalisation duration.
Keywords
percutaneous nephrostomy, retrograde ureteral stenting, acute obstructive uropathy
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CURRENT STATUS: Under Review
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Posted 28 Dec, 2020
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Editorial decision: Major revision
On 01 Feb, 2021
Review #2 received
Received 13 Jan, 2021
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Received 13 Jan, 2021
Review #1 received
Received 13 Jan, 2021
Review #3 received
Received 13 Jan, 2021
Reviewer #4 agreed
On 10 Jan, 2021
Reviewer #6 agreed
On 10 Jan, 2021
Reviewer #3 agreed
On 10 Jan, 2021
Reviewer #2 agreed
On 10 Jan, 2021
Reviewer #11 agreed
On 06 Jan, 2021
Reviewer #7 agreed
On 06 Jan, 2021
Reviewer #14 agreed
On 06 Jan, 2021
Reviewer #16 agreed
On 06 Jan, 2021
Reviewer #1 agreed
On 06 Jan, 2021
Reviewer #13 agreed
On 06 Jan, 2021
Reviewer #9 agreed
On 06 Jan, 2021
Reviewer #10 agreed
On 06 Jan, 2021
Reviewer #5 agreed
On 06 Jan, 2021
Reviewer #12 agreed
On 06 Jan, 2021
Reviewer #15 agreed
On 06 Jan, 2021
Reviewer #8 agreed
On 06 Jan, 2021
Reviewers invited
Invitations sent on 02 Jan, 2021
Editor assigned
On 28 Dec, 2020
Editor invited
On 22 Dec, 2020
Submission checks complete
On 22 Dec, 2020
First submitted
On 13 Dec, 2020
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Subject Areas
Urology & Nephrology
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This preprint is under consideration at Scientific Reports. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Percutaneous Nephrostomy Versus Retrograde Ureteral Stenting for Acute Obstructive Uropathy: A Systematic Review and Meta-Analysis
MOHD SHAFIE ABDULLAH
Universiti Sains Malaysia
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 28 Dec, 2020
No community comments so far
Editorial decision: Major revision
On 01 Feb, 2021
Review #2 received
Received 13 Jan, 2021
Review #4 received
Received 13 Jan, 2021
Review #1 received
Received 13 Jan, 2021
Review #3 received
Received 13 Jan, 2021
Reviewer #4 agreed
On 10 Jan, 2021
Reviewer #6 agreed
On 10 Jan, 2021
Reviewer #3 agreed
On 10 Jan, 2021
Reviewer #2 agreed
On 10 Jan, 2021
Reviewer #11 agreed
On 06 Jan, 2021
Reviewer #7 agreed
On 06 Jan, 2021
Reviewer #14 agreed
On 06 Jan, 2021
Reviewer #16 agreed
On 06 Jan, 2021
Reviewer #1 agreed
On 06 Jan, 2021
Reviewer #13 agreed
On 06 Jan, 2021
Reviewer #9 agreed
On 06 Jan, 2021
Reviewer #10 agreed
On 06 Jan, 2021
Reviewer #5 agreed
On 06 Jan, 2021
Reviewer #12 agreed
On 06 Jan, 2021
Reviewer #15 agreed
On 06 Jan, 2021
Reviewer #8 agreed
On 06 Jan, 2021
Reviewers invited
Invitations sent on 02 Jan, 2021
Editor assigned
On 28 Dec, 2020
Editor invited
On 22 Dec, 2020
Submission checks complete
On 22 Dec, 2020
First submitted
On 13 Dec, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Urology & Nephrology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Acute obstructive uropathy is associated with significant morbidity among patients with any condition that leads to urinary tract obstruction. Immediate urinary diversion is necessary to prevent further damage to the kidneys. In many centres, the two main treatment options include percutaneous nephrostomy (PCN) and retrograde ureteral stenting (RUS). The purpose of this study if to compare the efficacy and safety of PCN and RUS for the treatment of acute obstructive uropathy.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL, EMBASE, the World Health Organisation International Clinical Trials Registry Platform and ClinicalTrials.gov. We also searched the reference lists of included studies to identify any additional trials. We included randomised controlled trials and controlled clinical trials comparing the outcomes of clinical improvement (septic parameters and hospitalisation duration), quality of life, urinary-related symptoms, failure rates, post-procedural pain [measured using a visual analogue scale (VAS)] and analgesics use. We conducted statistical analyses using random effects models and expressed the results as risk ratio (RR) and risk difference (RD) for dichotomous outcomes and mean difference (MD) for continuous outcomes, with 95% confidence intervals (CIs).
Seven trials were identified that included 667 patients. Meta-analysis of the data revealed no difference in the two methods in improvement of septic parameters, quality of life, failure rates, post-procedural pain (VAS), or analgesics use. Patients receiving PCN had lower rates of haematuria and dysuria post-operatively and longer hospitalisation duration than those receiving RUS. PCN and RUS are effective for the decompression of an obstructed urinary system, with no significant difference in most outcomes. However, PCN is preferable to RUS because of its reduced impact on the patient’s post-operative quality of life due to haematuria and dysuria, although it is associated with slightly longer hospitalisation duration.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9
Figure 10
Figure 11
Figure 12
Figure 13
Figure 14
Figure 15
Figure 16
Figure 17
Figure 18
Due to technical limitations, full-text HTML conversion of this manuscript could not be completed. However, the manuscript can be downloaded and accessed as a PDF.