Retrograde ureteric stent placement versus percutaneous nephrostomy for acute infected ureteral obstruction in diabetic patients

doi:10.3877/cma.j.issn.1674-3253.2022.06.008

Abstract

Abstract:

Objective

To compare the outcomes of retrograde ureteric stent placement (USP) and percutaneous nephrostomy (PCN) as initial drainage methods in diabetic patients with acute infected ureteral obstruction secondary to calculi.

Methods

From January 2018 to June 2021, 118 diabetic patients with acute infected ureteral obstruction were included. Data were obtained retrospectively and the outcomes were measured by failure rates of intervention, complications, period for return to creatinine (Cr) nadir, admission to intensive care unit (ICU), and all-cause mortality during hospital admission.

Results

There were 118 patients included, and each group had 30 patients entered the final analysis after propensity score matching. Treatment failure rate and drainage effect were similar between USP and PCN group. Both groups showed equivalent outcomes in operation time, pain scores, Cr nadir, time to Cr nadir, time to normal white blood cells, time to normal temperature, and admissios to ICU. However, there were more complications and more patients with complications in PCN group (P<0.05).

Conclusion

Both USP and PCN were accepted options as initial drainage operations for acute infected ureteral obstruction in diabetic patients, but USP would be superior with less complications.

Key words: Retrograde ureteric stent placement, Percutaneous nephrostomy, Urolithiasis, Infection, Diabetes

Ren Liang, Chaojun Deng, Yingzhao Huo, Jing Yu. Retrograde ureteric stent placement versus percutaneous nephrostomy for acute infected ureteral obstruction in diabetic patients[J]. Chinese Journal of Endourology(Electronic Edition), 2022, 16(06): 523-527.

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References 17

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组别	例数	年龄(岁)^b	性别[例(%)]		体质量指数(kg/m²)^b	积水程度[例(%)]			结石大小(mm)^b	结石数目[例(%)]
组别	例数	年龄(岁)^b	男	女	体质量指数(kg/m²)^b	轻度	中度	重度	结石大小(mm)^b	单发	多发
USP	66	50(24~78)	37(56.1)	29(43.9)	25.3(18.4~31.7)	26(39.4)	28(23.7)	12(10.2)	8(4~25)	54(81.8)	12(18.2)
PCN	52	52(21~76)	31(59.6)	21(40.4)	26.2(18.9~31.2)	4(7.6)	24(46.2)	24(46.2)	13(5~29)	43(82.7)	09(17.3)
统计值		Z=-0.469	χ²=0.151		Z=-0.645	χ²=19.048			Z=-2.758	χ²=0.015
P值	-	0.639	0.698		0.519	<0.001			0.006	0.902
组别	结石位置[例(%)]			输尿管侧		血白细胞(×10⁹/L)^b	血肌酐(μmol/L)^b	糖化血红蛋白(%)^b	餐后血糖(mmol/L)^b	空腹血糖(mmol/L)^b
组别	上段	中段	下段	左侧	右侧	血白细胞(×10⁹/L)^b	血肌酐(μmol/L)^b	糖化血红蛋白(%)^b	餐后血糖(mmol/L)^b	空腹血糖(mmol/L)^b
USP	48(72.7)	12(18.2)	6(9.1)	38(57.6)	28(42.4)	13.3(2.8~32.3)	125.6(56.1~347.7)	6.5(4.5~8.9)	10.4(6.3~21.8)	6.6(4.1~10.3)
PCN	42(80.8)	06(11.5)	4(7.7)	28(53.8)	24(46.2)	14.9(2.4~36.7)	131.5(58.3~355.4)	6.9(4.7~8.5)	10.8(6.9~18.7)	6.2(4.5~11.2)
统计值	χ²=1.177			χ²=0.164		Z=-1.388	Z=-0.943	Z=-1.147	Z=-1.190	Z=-1.510
P值	0.562			0.685		0.165	0.346	0.251	0.234	0.131

组别	例数	年龄(岁)^b	性别[例(%)]		体质量指数(kg/m²)^b	积水程度[例(%)]			结石大小(mm)^b	结石数目[例(%)]
组别	例数	年龄(岁)^b	男	女	体质量指数(kg/m²)^b	轻度	中度	重度	结石大小(mm)^b	单发	多发
USP	66	50(24~78)	37(56.1)	29(43.9)	25.3(18.4~31.7)	26(39.4)	28(23.7)	12(10.2)	8(4~25)	54(81.8)	12(18.2)
PCN	52	52(21~76)	31(59.6)	21(40.4)	26.2(18.9~31.2)	4(7.6)	24(46.2)	24(46.2)	13(5~29)	43(82.7)	09(17.3)
统计值		Z=-0.469	χ²=0.151		Z=-0.645	χ²=19.048			Z=-2.758	χ²=0.015
P值	-	0.639	0.698		0.519	<0.001			0.006	0.902
组别	结石位置[例(%)]			输尿管侧		血白细胞(×10⁹/L)^b	血肌酐(μmol/L)^b	糖化血红蛋白(%)^b	餐后血糖(mmol/L)^b	空腹血糖(mmol/L)^b
组别	上段	中段	下段	左侧	右侧	血白细胞(×10⁹/L)^b	血肌酐(μmol/L)^b	糖化血红蛋白(%)^b	餐后血糖(mmol/L)^b	空腹血糖(mmol/L)^b
USP	48(72.7)	12(18.2)	6(9.1)	38(57.6)	28(42.4)	13.3(2.8~32.3)	125.6(56.1~347.7)	6.5(4.5~8.9)	10.4(6.3~21.8)	6.6(4.1~10.3)
PCN	42(80.8)	06(11.5)	4(7.7)	28(53.8)	24(46.2)	14.9(2.4~36.7)	131.5(58.3~355.4)	6.9(4.7~8.5)	10.8(6.9~18.7)	6.2(4.5~11.2)
统计值	χ²=1.177			χ²=0.164		Z=-1.388	Z=-0.943	Z=-1.147	Z=-1.190	Z=-1.510
P值	0.562			0.685		0.165	0.346	0.251	0.234	0.131

组别	例数	年龄(岁)^b	性别		体质量指数(kg/m²)^b	积水程度[例(%)]			结石大小(mm)^b	结石数目[例(%)]
组别	例数	年龄(岁)^b	男	女	体质量指数(kg/m²)^b	轻度	中度	重度	结石大小(mm)^b	单发	多发
USP	30	51(24~74)	17(56.7)	13(43.3)	25.6(21.5~30.8)	6(20.0)	17(56.7)	7(23.3)	14(6~23)	25(83.3)	5(16.7)
PCN	30	52(23~75)	18(60.0)	12(40.0)	26.0(20.3~31.2)	4(13.3)	18(60.0)	8(26.7)	17(7~29)	26(86.7)	4(13.3)
统计值	-	Z=-0.385	χ²=0.069		Z=-0.643	χ²=0.495			Z=-0.572	χ²=0.131
P值	-	0.700	0.793		0.520	0.781			0.568	0.718
组别	结石位置[例(%)]			输尿管侧		血白细胞(×10⁹/L)^b	血肌酐(μmol/L)^b	糖化血红蛋白(%)^b	餐后血糖(mmol/L)^b	空腹血糖(mmol/L)^b
组别	上段	中段	下段	左侧	右侧	血白细胞(×10⁹/L)^b	血肌酐(μmol/L)^b	糖化血红蛋白(%)^b	餐后血糖(mmol/L)^b	空腹血糖(mmol/L)^b
USP	18(60.0)	7(23.3)	5(16.7)	16(53.3)	14(46.7)	14.3(2.8~26.5)	145.4(57.8~341.5)	6.8(5.8~8.6)	10.6(8.1~21.2)	6.7(5.0~10.1)
PCN	21(70.0)	5(16.7)	4(13.3)	14(46.7)	16(53.3)	14.6(2.9~21.9)	141.8(58.9~325.1)	6.9(5.9~8.5)	10.9(7.9~17.9)	6.5(5.2~11.0)
统计值	-			χ²=0.267		Z=-0.281	Z=-0.399	Z=-0.282	Z=-0.245	Z=-0.222
P值	0.748^a			0.606		0.779	0.690	0.779	0.803	0.824

组别	例数	年龄(岁)^b	性别		体质量指数(kg/m²)^b	积水程度[例(%)]			结石大小(mm)^b	结石数目[例(%)]
组别	例数	年龄(岁)^b	男	女	体质量指数(kg/m²)^b	轻度	中度	重度	结石大小(mm)^b	单发	多发
USP	30	51(24~74)	17(56.7)	13(43.3)	25.6(21.5~30.8)	6(20.0)	17(56.7)	7(23.3)	14(6~23)	25(83.3)	5(16.7)
PCN	30	52(23~75)	18(60.0)	12(40.0)	26.0(20.3~31.2)	4(13.3)	18(60.0)	8(26.7)	17(7~29)	26(86.7)	4(13.3)
统计值	-	Z=-0.385	χ²=0.069		Z=-0.643	χ²=0.495			Z=-0.572	χ²=0.131
P值	-	0.700	0.793		0.520	0.781			0.568	0.718
组别	结石位置[例(%)]			输尿管侧		血白细胞(×10⁹/L)^b	血肌酐(μmol/L)^b	糖化血红蛋白(%)^b	餐后血糖(mmol/L)^b	空腹血糖(mmol/L)^b
组别	上段	中段	下段	左侧	右侧	血白细胞(×10⁹/L)^b	血肌酐(μmol/L)^b	糖化血红蛋白(%)^b	餐后血糖(mmol/L)^b	空腹血糖(mmol/L)^b
USP	18(60.0)	7(23.3)	5(16.7)	16(53.3)	14(46.7)	14.3(2.8~26.5)	145.4(57.8~341.5)	6.8(5.8~8.6)	10.6(8.1~21.2)	6.7(5.0~10.1)
PCN	21(70.0)	5(16.7)	4(13.3)	14(46.7)	16(53.3)	14.6(2.9~21.9)	141.8(58.9~325.1)	6.9(5.9~8.5)	10.9(7.9~17.9)	6.5(5.2~11.0)
统计值	-			χ²=0.267		Z=-0.281	Z=-0.399	Z=-0.282	Z=-0.245	Z=-0.222
P值	0.748^a			0.606		0.779	0.690	0.779	0.803	0.824

组别	例数	失败[例(%)]	并发症事件数[例(%)]							并发症患者例数[例(%)]	手术时间(min)^b
组别	例数	失败[例(%)]	黏膜损伤	尿外渗	管脱落	切口感染	管堵塞	肉眼血尿	大出血	并发症患者例数[例(%)]	手术时间(min)^b
USP	30	1(3.3)	4	0	1	0	1	4	0	4(13.3)	11(5~22)
PCN	30	1(3.3)	0	4	1	3	0	13	1(3.3)	11(36.7)	13(5~25)
统计值		-	χ²=9.463							χ²=4.356	Z=-0.481
P值		1.000	0.002							0.037	0.631
组别	VAS疼痛评分^b	最低肌酐值(μmol/L)^b	体温恢复时间(d)^b	白细胞正常时间(d)^b	到达最低肌酐时间(d)^b	死亡[例(%)]	入住ICU[例(%)]	自主排石[例(%)]	结石清除手术方式[例(%)]
组别	VAS疼痛评分^b	最低肌酐值(μmol/L)^b	体温恢复时间(d)^b	白细胞正常时间(d)^b	到达最低肌酐时间(d)^b	死亡[例(%)]	入住ICU[例(%)]	自主排石[例(%)]	输尿管镜	经皮肾镜
USP	4(0~8)	73.5(53.2~155.8)	2.5(1~15)	3(1~9)	3(1~8)	0	2(6.7)0	0	18(60.0)	12(40.0)
PCN	4.5(1~8)	87.7(51.4~148.9)	03(1~14)	4(1~9)	3(1~7)	1(3.3)	3(10.0)	4(13.3)	09(30.0)	21(70.0)
统计值	Z=-1.497	Z=-0.968	Z=-0.463	Z=-0.135	Z=-0.38	-	-	-	χ²=0.455
P值	0.134	0.334	0.643	0.893	0.703	-	-	-	0.020

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