Percutaneous nephrostomy versus ureteral stents for diversion of hydronephrosis caused by stones: A prospective, randomized clinical trial

Purpose: Urinary diversion with percutaneous nephrostomy or ureteral stent is indicated by symptoms, such as persistent colic, high temperature and ur emia, of hydronephrosis caused by stones. We evaluate which of these 2 meth ods is superior concerning the course of procedure, relief of accompanying symptoms and quality of life in regard to patient age and sex. Materials and Methods: A total of 40 patients with stone induced hydronephr osis were randomized into either percutaneous nephrostomy or stent insertio n groups. These patients were then evaluated by procedure (use of analgesic s, x-ray exposure, success of insertion), relief of accompanying symptoms ( duration of diversion, intravenous administration of antibiotics for high t emperature) and quality of life (questionnaire immediately and 2 to 4 weeks postoperatively). Results: Two comparable groups of patients were formed, with an average age of 55 versus 49 years and a male-to-female ratio of 12:8 versus 9:11 for t hose who underwent percutaneous nephrostomy versus those who received a ste nt, respectively. Percutaneous nephrostomy was successfully completed in 10 0% of patients and stents were successful in 80%, with a 20% conversion to percutaneous nephrostomy. The x-ray exposure was shorter in the percutaneou s nephrostomy group (p = 0.052). Administration of analgesics was more freq uent in the stent group (p = 0.061). Percutaneous nephrostomy indwelling ti me was shorter (50% less than 2 weeks) than that of stents (25% less than 2 weeks, p = 0.043). Antibiotics were administered for greater than 5 days i n 0% of patients who underwent percutaneous nephrostomy versus 64% in those with stents (p = 0.174). Reduction in quality of life was moderate but mor e pronounced in patients with stents compared to those who underwent percut aneous nephrostomy, and was more distinct in males and younger patients. Th e quality of life progressively improved in the course of diversion with pe rcutaneous nephrostomy but deteriorated with stents. Conclusions: Our results demonstrated that percutaneous nephrostomy is supe rior to ureteral stents for diversion of hydronephrosis caused by stones, e specially in patients with a high temperature, as well as in males and juve niles.