Nephrostomy tube versus ureteral stent for obstructing septic calculi: A nationwide propensity score–matched analysis

Abstract

Background: Sepsis secondary to obstructive uropathy is a urological emergency that requires urgent decompression using placement of a percutaneous nephrostomy tube (PCN) or retrograde ureteric stent (RUS). Whether selection of PCN or RUS impacts mortality remains uncertain. Methods: We conducted a retrospective cohort analysis using the 2006–2014 Nationwide Inpatient Sample (NIS) of 34,009 patients with sepsis and obstructive uropathy who were treated with RUS or PCN. The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay, need for mechanical ventilation, and need for dialysis. Multivariate logistic regression and propensity matched analyses were used to evaluate the effect of PCN or RUS on in-hospital mortality. Results: A total of 9,828 (28.9%) patients were treated with PCN and 24,181 (71.1%) with RUS. The unadjusted mortality for PCN and RUN patients was 5.3% and 2.8%, respectively. Those treated with PCN had a higher likelihood of requiring mechanical ventilation or hemodialysis. In the multivariate logistic regression analysis, RUS had lower odds of mortality compared to PCN (OR 0.72; 95% CI 0.63 to 0.83, p < 0.01). After propensity score matching, the mortality for the RUS group was 3.4% and 4.0% for the PCN group ( p = 0.19). Conclusion: There were no significant differences in mortality for patients treated with PCN versus RUS after propensity matching. Method of decompression should be guided by local practice. Further prospective randomized trials are needed.