Nephrostomy tube versus double J ureteral stent in patients with malignant ureteric obstruction. A systematic review and meta-analysis of comparative studies.

Content Provider	Europe PMC
Author	Gauhar, Vineet Pirola, Giacomo Maria Scarcella, Simone Angelis, Maria Vittoria De Giulioni, Carlo Rubilotta, Emanuele Gubbiotti, Marilena Lim, Ee Jean Law, Yu Xi Terence Wroclawski, Marcelo Langer Tiong, Ho Yee Castellani, Daniele
Abstract	ABSTRACTPurposeWe aimed to perform a systematic review to assess perioperative outcomes, complications, and survival in studies comparing ureteral stent and percutaneous nephrostomy in malignant ureteral obstruction.Materials and MethodsThis review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Meta-analyses were performed on procedural data; outcomes; complications (device-related, accidental dislodgement, febrile episodes, unplanned device replacement), dislodgment, and overall survival. Continuous variables were pooled using the inverse variance of the mean difference (MD) with a fixed effect, and 95% confidence interval (CI). The incidences of complications were pooled using the Cochran-Mantel-Haenszel method with the random effect model and reported as Odds Ratio (OR), and 95% CI. Statistical significance was set two-tail p-value <0.05ResultsTen studies were included. Procedure time (MD −10.26 minutes 95%CI −12.40-8.02, p<0.00001), hospital stay (MD −1.30 days 95%CI −1.69 − −0.92, p<0.0001), number of accidental tube dislodgments (OR 0.25 95% CI 0.13 – 0.48, p<0.0001) were significantly lower in the stent group. No difference was found in mean fluoroscopy time, decrease in creatinine level post procedure, overall number of complications, interval time between the change of tubes, number of febrile episodes after diversion, unplanned device substitution, and overall survival.ConclusionOur meta-analysis favors stents as the preferred choice as these are easier to maintain and ureteral stent placement should be recommended whenever feasible. If the malignant obstruction precludes a stent placement, then PCN is a safe alternative.
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Page Count	12
ISSN	16775538
Journal	International Brazilian Journal of Urology : Official Journal of the Brazilian Society of Urology [Int Braz J Urol]
Volume Number	48
PubMed Central reference number	PMC9747026
Issue Number	6
PubMed reference number	36037256
e-ISSN	16776119
DOI	10.1590/s1677-5538.ibju.2022.0225
Language	English
Publisher	Sociedade Brasileira de Urologia
Publisher Date	2022-11-01
Access Restriction	Open
Rights License	This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Subject Keyword	Ureteral Obstruction Nephrostomy, Percutaneous Urinary Diversion
Content Type	Text
Resource Type	Article
Subject	Urology