Pyeloplasty for hydronephrosis: Issues of double J stent versus nephrostomy tube as drainage technique

Abstract

Aims:

To compare the efficacy, complications, cost analysis and hospital stay between two methods of drainage of the kidney: double J (DJ) stent versus nephrostomy tube following open pyeloplasty for ureteropelvic junction obstruction hydronephrosis.

Patients and Methods:

This was a prospective randomized study of 20 patients in each group over 14 months. Pre and post-operative (3 months) function and drainage were assessed by ethylenedicysteine scan and intravenous urogram.

Results:

Both groups showed similar good improvement in function and drainage. Nephrostomy group had significantly longer hospital stay ( P < 0.001) but incurred less cost. Complications with nephrostomy included tube breakage ( n = 1) and urine leak after tube removal ( n = 2). DJ stents were associated with stent migration ( n = 4), increased frequency of micturition ( n = 9), dysuria ( n = 4) and urinary tract infection ( n = 1).

Conclusion:

Both methods of drainage did not interfere with improvement after pyeloplasty. Minor complications were more with DJ stent ( P = 0.0003). Although overall cost of treatment was more with stents, they reduced length of hospital stay. Optimal length of stent is essential to reduce complications secondary to migration and bladder irritation.