Percutaneous Nephrostomy Versus Retrograde Ureteral Stent for Management of Malignant Ureteral Obstruction in Adults: a Systematic Review of the Literature
Abstract
Background Malignant ureteral obstruction (MUO) is a common presentation in advanced urological and
non-urological malignancies. Percutaneous nephrostomy (PCN) and retrograde ureteral stent (RUS) are the most
commonly performed procedures to relieve the obstruction. The comparative effectiveness of PCN and RUS for
decompression of MUO remains uncertain.
Purpose To systematically review the literature for evidence of improved efficacy of one of these procedures in
terms of renal function preservation and clinical outcomes.
Methods We searched Ovid Medline, Ovid EMBASE, CINAHL, Cochrane Central Register of Controlled Trials
(CENTRAL), and Scopus from the date of inception to October 2022. In addition, gray literature was searched
through OpenGray (https://opengrey.eu/), dissertation and thesis database (ProQuest) via (https://www.proquest.
com), and Clinical trial.gov website. The reference lists of all the included studies were also searched.
Two reviewers independently reviewed and selected studies, assessed the quality, and extracted the data.
Results Overall, 25 eligible studies including 1864 patients compared PCN and RUS (head-to-head). PCN and
RUS were found to be similarly effective in improving renal function. However, PCN appears to be superior in
maintaining this reduction. The complication rate and quality of life were comparable between the 2 methods, but the
length of hospital stay and the financial cost were significantly higher in the PCN group. The mean technical success
rate in RUS was 70.3% (21% to 100%) and in PCN was 98.8% (90% to 100%). The conversion rate from RUS to PCN
ranged from 10% to 42.6% (mean = 22.5%), while internalization of the PCN occurred in 11.7% to 98% of the patients
(mean = 45.5%).
Conclusions Both diversional methods are effective in management of MUO. However, because of the heterogeneity
of the included studies, the superiority of one of the procedures cannot be concluded.
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