Comparison of nephrostomy and double-J stent in the management of percutaneous nephrolithotomy–induced renal pelvis trauma: A prospective randomized controlled trial

Abstract

Objective: This study aimed to compare the efficacy of nephrostomy versus double-J (DJ) ureteral stent in managing kidney pelvis trauma during percutaneous nephrolithotomy (PCNL) procedures.

Methodology: This prospective parallel-group clinical trial involved 60 PCNL patients diagnosed with kidney pelvis perforation during PCNL through nephroscopy (inclusion criteria). Exclusion criteria comprised a history of previous renal surgery or prior PCNL. Eligible patients were alternately assigned to either the insertion of a nephrostomy or a ureteral DJ stent.

Results: A total of 31 patients were included in the nephrostomy group, and 29 were in the DJ group. The mean ± SD of operation duration in nephrostomy and DJ groups were 50.8 ± 23.7 and 45.7 ± 19.3 min, respectively (P = .17). Two-access PCNLs were performed in 13% and 18% of PCNL operations in the nephrostomy and DJ groups, respectively (P = .72). In the nephrostomy group, 5 patients (17%) had urinoma collection around the kidney, compared with 11 (39%) in the DJ group, showing a statistically significant difference between the two groups (P = .036). Post-operative fever and urinary leakage were observed in 48% and 32% of patients in nephrostomy group versus 44% and 22% of patients in group DJ (P = .76 and P = .39).

Conclusion: The findings of this study indicate a higher percentage of urinoma detected one week after the insertion of a ureteral DJ compared with nephrostomy in PCNL patients who experienced renal pelvis injury during the operation.

Keywords

nephrolithiasis / nephrostomy / percutaneous nephrolithotomy / renal trauma / ureteral catheter

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