Meta-analysis of perioperative results and safety of percutaneous nephrostomy and retrograde ureteral stenting in the treatment of acute obstructive upper urinary tract infection

Gang WU; Xidong WANG; Yuanshan CUI; Jitao WU

ABSTRACT

Objective:

To compare the perioperative outcomes and safety of percutaneous nephrostomy (PCN) and retrograde ureteral stenting (RUS) in the treatment of acute obstructive upper urinary tract infection.

Methods:

A comprehensive search was performed on the MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials to identify relevant literatures. The retrieval period was from the establishment of the database to August 2022. Inclusion criteria ①Randomized controlled trial (RCT) of PCN and RUS in the treatment of acute obstructive upper urinary tract infection; ②Studies provided accurate data for analysis, including the total number of subjects and the results of each index; ③The full text of the study was available, and different literatures published in the same cohort were included in the newly published data. ④The observation indexes included the time for the recovery of body temperature, creatinine, leukocyte, operation, radiation exposure, postoperative fever, postoperative pain, and the incidence of postoperative fistulotomy or stent displacement. Exclusion criteria ①non-RCT study; ②unable to obtain the full text. Two researchers independently screened the literature and evaluated the literature quality, and all the statistical data were analyzed by RevMan5.3 software.

Results:

Seven trials enrolled 727 patients were included in the meta-analysis, 412 in the PCN group and 315 in the RUS group included. Meta-analysis revealed that the advantages of PCN were lower incidence of postoperative hematuria ( OR=0.54, 95% CI 0.30-0.99, P=0.040) and lower incidence of insertion failure ( OR=0.42, 95% CI 0.21-0.81, P=0.010), but the fluoroscopy time of RUS group was shorter than that of PCN group ( MD=0.31, 95% CI 0.14-0.48, P<0.01). Moreover, there was no significant difference in time to normalization of temperature, time to normalization of creatinine, time to normalization of WBC, operative time, postoperative fever, postoperative pain, postoperative nephrostomy tube or stent slippage rate between the two surgical methods( P>0.05).

Conclusions:

The radiation exposure time of PCN was longer than that of RUS, but the incidence of postoperative hematuria and catheterization failure was lower than that of RUS.