Nephrostomy Tube Versus Ureteral Stent for Obstructing Septic Calculi: A Nationwide Propensity Score-matched Analysis

Area of Science:

• Urology
• Critical Care Medicine
• Nephrology

Background:

• Sepsis secondary to obstructive uropathy is a critical condition necessitating prompt urinary decompression.
• Percutaneous nephrostomy tubes (PCN) and retrograde ureteric stents (RUS) are common decompression methods, but their comparative impact on mortality is unclear.

Purpose of the Study:

• To investigate the association between the choice of decompression method (PCN vs. RUS) and in-hospital mortality in patients with sepsis and obstructive uropathy.
• To analyze secondary outcomes including length of stay, mechanical ventilation, and dialysis requirements.

Main Methods:

• Retrospective cohort analysis of 34,009 patients from the 2006-2014 Nationwide Inpatient Sample (NIS).
• Patients with sepsis and obstructive uropathy treated with either PCN or RUS were included.
• Multivariate logistic regression and propensity score matching were employed to assess the impact of PCN versus RUS on mortality.

Main Results:

• Unadjusted mortality was higher in the PCN group (5.3%) compared to the RUS group (2.8%).
• Multivariate analysis indicated lower odds of mortality with RUS (OR 0.72; 95% CI 0.63-0.83).
• However, after propensity score matching, no significant difference in mortality was observed between the PCN (4.0%) and RUS (3.4%) groups (p=0.19).

Conclusions:

• No significant difference in in-hospital mortality exists between PCN and RUS for sepsis secondary to obstructive uropathy when accounting for patient characteristics through propensity matching.
• Treatment selection should be based on established local practices and patient-specific factors.
• Further high-quality prospective randomized trials are warranted to definitively establish the optimal decompression strategy.