Comparative Study of Mono J Single-Step Versus Two-Step Balloon Nephrostomy Placement for Urinary Tract Obstruction:...

Background: Urinary tract obstruction can lead to severe renal impairment if not managed effectively. Nephrostomy placement is a critical intervention to relieve such obstructions. The aim of this study was to compare the mono J single-step nephrostomy and the two-step balloon nephrostomy techniques in terms of procedural efficiency, patient tolerability, and complication rates. Methods: A prospective randomized observational design was employed, including patients requiring nephrostomy placement due to oncological conditions, urinary tract lithiasis, or functional disorders. Patients were randomized into two groups based on the different method of nephrostomy tube placement: one with the mono J single-step method and the other with the two-step balloon method. The primary outcomes were to compare the average placement time, the accuracy of the tube placement between methods, and reported complications at 3, 6, 9, and 12 months, verified through immediate post-procedural imaging. Secondary outcomes evaluated post-procedure pain levels were using the visual analogue scale (VAS) between the two methods. Results: The mono J single-step method had a significantly shorter average placement time (Mann-Whitney, W = 367.5, p = 0.006), while the two-step method demonstrated better early tube stability, as evidenced by fewer dislocations at 3 months (Chi-square, χ²(1) = 4.828, p = 0.028, Cramer's V = 0.28) and 6 months (Chi-square, χ²(1) = 5.198, p = 0.023, Cramer's V = 0.29). No significant differences between methods were recorded at 6 and 12 months. Patient tolerability was comparable between the two methods, and no significant difference was reported. Conclusions: Although the mono J single-step technique is more time-efficient, the two-step balloon method offers advantages in early tube stability, providing valuable insights for optimizing clinical decision-making in nephrostomy placement.