Ureteric Stenting and Percutaneous Nephrostomy Insertion for Acute Ureteric Obstruction: A Multi-centered Prospective Study to Compare the Quality of Life between both Procedures

Abstract

Background: To compare the quality of life and pain scores between double J ureteric stenting and percutaneous nephrostomy (PCN) insertion in patients who presented with acute ureteral obstruction secondary to urolithiasis. Methods: This is a prospective, multi-centre study which compares the quality of life in patients who have either done nephrostomy tube insertion or double J ureteral stenting. This study was performed over a span of 18 months at two urology centres in Malaysia. 40 double J ureteric stents and 40 percutaneous nephrostomy tube patients were recruited for this study. Patients’s pain scores and quality of life post procedures were assessed using the visual analogue scale and EuroQol questionnaires at 2 time points (Day1-2 and at 1 month post drainage). Results: The patients’ demographics and pre-drainage data were similar except for where the stones were located. Most of the patients with proximal ureteric stones (75%) and those who presented with fever or sepsis (76%) underwent PCN insertion. At time 0, although both groups achieved similar overall QoL and pain scores, more post PCN patients reported difficulties in self-care (p=0.002), mobility (p=0.041) and resuming usual activities (p=0.012). Symptoms in PCN group improved with time, translating in the higher QoL scores at time 1. In contrary, more double J ureteric stenting patients presented to the emergency room with complaints related to their procedure. Moreover, their assessments scores deteriorated over time, and they had a significant higher score in the pain domain compared to PCN patients at time1 (p=0.014). Conclusion: Both double J ureteric stenting and PCN have negative impacts on a patient’s quality of life. Particularly in usual activities, pain and mobility. If there is a delay in definitive treatment, this study supports the usage of PCN as opposed to double J ureteric stenting. This is evidenced by a marked improvement in a patient’s quality of life score and wellness score with time. In contrary, with the use of double J ureteric stenting, the quality of life and wellness outcomes significantly deteriorates over time as compared to those who have PCN.