Wei Hu, Jing-Jing Lou, Ze-Peng Wu, Xiang Hu, Lidiao Li, Yu-Han He
In this retrospective cohort of patients with recurrent ipsilateral stone-related infectious obstruction who achieved infection control and subsequently underwent RIRS, PCN was associated with a shorter time to the first recorded body temperature below 37.3 °C, a shorter length of stay during the decompression admission, a shorter recorded RIRS operative time, and a shorter postoperative hospital stay than DJ stenting, while stone-free rates were comparable. Because of the retrospective and non-randomized design, these findings should be interpreted as associations rather than causal effects.
PURPOSE: To compare percutaneous nephrostomy (PCN) and double-J (DJ) stenting as emergency decompression modalities in patients with recurrent ipsilateral stone-related infectious obstruction with systemic inflammatory response who subsequently underwent retrograde intrarenal surgery (RIRS) after infection control.
METHODS: This retrospective cohort study enrolled 69 patients (PCN, n = 35; DJ, n = 34) who underwent emergency decompression followed by retrograde intrarenal surgery (RIRS). Emergency decompression and perioperative RIRS outcomes were compared.
RESULTS: Baseline demographic and clinical characteristics were comparable between the groups. The drainage procedure time was longer in the PCN group than in the DJ group (42.53 ± 11.34 vs. 32.69 ± 10.72 min; MD, 9.84 min; 95% CI, 4.54 to 15.14; P < 0.001). However, PCN was associated with a shorter time to the first recorded body temperature below 37.3 °C after decompression (2.94 ± 1.26 vs. 4.36 ± 1.58 h; MD, -1.42 h; 95% CI, -2.11 to -0.73; P < 0.001) and a shorter length of stay during the decompression admission (3.26 ± 1.13 vs. 4.13 ± 1.29 days; MD, -0.87 days; 95% CI, -1.45 to -0.29; P = 0.004). During subsequent RIRS, UAS use was less frequent in the PCN group than in the DJ group (42.9% vs. 88.2%; RR, 0.49; 95% CI, 0.33 to 0.73; P < 0.001). The recorded RIRS operative time was shorter in the PCN group (50.35 ± 10.69 vs. 74.91 ± 14.35 min; MD, -24.56 min; 95% CI, -30.67 to -18.45; P < 0.001), as was postoperative hospital stay (2.84 ± 0.93 vs. 3.45 ± 1.28 days; MD, -0.61 days; 95% CI, -1.15 to -0.07; P = 0.028). Stone-free rates were comparable between the groups (91.4% vs. 88.2%; RR, 1.04; 95% CI, 0.88 to 1.22; P = 0.710).
CONCLUSION: In this retrospective cohort of patients with recurrent ipsilateral stone-related infectious obstruction who achieved infection control and subsequently underwent RIRS, PCN was associated with a shorter time to the first recorded body temperature below 37.3 °C, a shorter length of stay during the decompression admission, a shorter recorded RIRS operative time, and a shorter postoperative hospital stay than DJ stenting, while stone-free rates were comparable. Because of the retrospective and non-randomized design, these findings should be interpreted as associations rather than causal effects.