Double J stenting compared with ureteral catheterization in percutaneous Nephrolithotomy

摘要

Background:Nephrolithiasis represents a large portion in the field of Urological pathology. Minimal invasive and non-invasive therapies have become more accessible and efficient in the treatment of nephrolithiasis. Percutaneous nephrolithotomy (PCNL) is an effective minimal invasive modality of treating kidney stones.Objectives: To evaluate the outcome of standard percutaneous nephrolithotomy (PCNL) using two different stenting techniques i.e. externalized ureteral catheter placement compared with Double-J stent placement.Methods: This is a prospective study conducted from January 2012 to June 2013 at Kathmandu Medical College Teaching Hospital among patients undergoing percutaneous nephrolithotomy (PCNL). Fifty patients who underwent PCNL were divided into two equal groups: Group 1 (PCNL with Double-J stent placement) and Group 2 (PCNL with externalized ureteral catheter placement). Factors evaluated included stent-related symptoms, postoperative morbidity, and the cost. Morbidity was classified according to the Modified Clavien classification. SPSS 20 was used for statistical evaluation. P value less than 0.05 was considered significant.Results: Stent related morbidity were fever, dysuria, hematuria, burning micturition. Total of 16 stent related complications were seen in group 1 with four of the patients needing early surgical intervention to remove the Double J stent and injectable antibiotics for urinary tract complication due to in dwelling stent. In Group 2, seven patients experienced postoperative complications, out of which six were managed conservatively and one patient had grade III A dysuria and hematuria, who underwent immediate stent removal and received injectable antibiotics. There was no reported sepsis and mortality in both groups. Stent was removed in 3-4 weeks’ time in group 1 and 3-4 days in group 2. In Group 1, patients had to come one day prior for stent removal. Cost for DJ stent was significantly higher in group I than group II.Conclusion: Standard PCNL with externalized ureteral catheter is as feasible as Double-J stenting. Less cost can be a huge relief to the patients in the third world developing country.DOI: http://dx.doi.org/10.3126/jkmc.v3i2.11228Journal of Kathmandu Medical CollegeVol. 3, No. 2, Issue 8, Apr.-Jun., 2014Page : 63-67