Percutaneous nephrostomy vs. double-J stenting for emergency decompression in recurrent ipsilateral stone-related...

To compare percutaneous nephrostomy (PCN) and double-J (DJ) stenting as emergency decompression modalities in patients with recurrent ipsilateral stone-related infectious obstruction with systemic inflammatory response who subsequently underwent retrograde intrarenal surgery (RIRS) after infection control.

This retrospective cohort study enrolled 69 patients (PCN, n = 35; DJ, n = 34) who underwent emergency decompression followed by retrograde intrarenal surgery (RIRS). Emergency decompression and perioperative RIRS outcomes were compared.

Baseline demographic and clinical characteristics were comparable between the groups. The drainage procedure time was longer in the PCN group than in the DJ group (42.53 ± 11.34 vs. 32.69 ± 10.72 min; MD, 9.84 min; 95% CI, 4.54 to 15.14; P < 0.001). However, PCN was associated with a shorter time to the first recorded body temperature below 37.3 °C after decompression (2.94 ± 1.26 vs. 4.36 ± 1.58 h; MD, -1.42 h; 95% CI, -2.11 to -0.73; P < 0.001) and a shorter length of stay during the decompression admission (3.26 ± 1.13 vs. 4.13 ± 1.29 days; MD, -0.87 days; 95% CI, -1.45 to -0.29; P = 0.004). During subsequent RIRS, UAS use was less frequent in the PCN group than in the DJ group (42.9% vs. 88.2%; RR, 0.49; 95% CI, 0.33 to 0.73; P < 0.001). The recorded RIRS operative time was shorter in the PCN group (50.35 ± 10.69 vs. 74.91 ± 14.35 min; MD, -24.56 min; 95% CI, -30.67 to -18.45; P < 0.001), as was postoperative hospital stay (2.84 ± 0.93 vs. 3.45 ± 1.28 days; MD, -0.61 days; 95% CI, -1.15 to -0.07; P = 0.028). Stone-free rates were comparable between the groups (91.4% vs. 88.2%; RR, 1.04; 95% CI, 0.88 to 1.22; P = 0.710).

In this retrospective cohort of patients with recurrent ipsilateral stone-related infectious obstruction who achieved infection control and subsequently underwent RIRS, PCN was associated with a shorter time to the first recorded body temperature below 37.3 °C, a shorter length of stay during the decompression admission, a shorter recorded RIRS operative time, and a shorter postoperative hospital stay than DJ stenting, while stone-free rates were comparable. Because of the retrospective and non-randomized design, these findings should be interpreted as associations rather than causal effects.