Abstract

Purpose: This study compared the clinical benefits of double J (DJ) ureteral stenting with percutaneous nephrostomy (PCN) for the management of acute pyelonephritis (APN) with complicated ureteral stones.
Materials and Methods: The records of 85 patients with complicated APN between December 2006 and July 2017 were reviewed retrospectively. Sixty one patients who underwent DJ or PCN for the management of acute urinary obstruction were enrolled in this study. Some of the participants were excluded for concurrent renal stones, multiple ureteral stones, ureteral stricture, malignancy, and anatomical anomalies. The patient and stone characteristics and peri-procedural laboratory test results of the groups were compared. The success rate, depending on the type of urinary diversion and the presence of immediate complications, were also analyzed.
Results: In this study, 19 patients underwent DJ stenting, and 42 patients underwent PCN as a transient urinary diversion. No failed procedures or immediate complications requiring subsequent intervention were encountered (Clavien–Dindo grade II-V). Urologists preferred PCN to DJ stenting in cases with an elevated serum creatinine level (p=0.001) and higher C-reactive protein (CRP) level (p<0.001). The indicative parameters for renal injury and septic conditions (white blood cell count, segment neutrophil, and creatinine levels) tended to show immediate improvement, whereas CRP did not; however, the differences in markers were not significant (p=0.701, 0.962, 0.288, and 0.360, respectively).
Conclusions: Both DJ stenting and PCN were safe and feasible methods for the management of complicated APN. With experienced urologists or radiologists, there may be little danger of prolonged renal failure or other procedure-related complications.

• Keywords: Nephrostomy, percutaneous; Urinary diversion; Pyelonephritis; Ureterolithiasis; Ureteral obstruction