Category: Clinical Stones: Outcomes
Introduction & Objective : Urinary lithiasis is a common entity in the modern societies. In cases of complicated ureteral obstruction urinary diversion with nephrostomy tube (NT) or ureteral stent (JJ) are mandatory. Currently no evidence exists to support the superiority one method over the other. The objective of this study is to compare both diversion techniques regarding tolerability, quality of life and adverse symptoms after these procedures.
A total of 50 patients with complicated renal colic caused by ureteral stone with criteria for urinary diversion were enrolled randomly in this study. Demographic and anthropometric characteristics as well as medical history were recorded. Life quality and adverse symptoms were assessed by EuroQolEQ-5D- 3L® Portuguese version (EQ-5D + EQ-VAS) and Intervention Specific Questionnaire. The patients were prospectively followed and evaluated before and after the urinary diversion procedure.
Results : 32 patients (64%) were derived with JJ and 18 (36%) with NT. Regarding the EQ-5D index scores, there was a statistic significant decrease in the score after the procedure for both groups (JJ group p=0,011; NT group p=0,013), yet no significant difference was found between the groups post-score (p=0,791). The EQ VAS’s median difference between pre and post intervention was -5,00 points for JJ group and 0,00 points for NT group, (p=0,004), reflecting a decrease in the overall health state. Patients in JJ group experienced more urinary symptoms, mostly haematuria (68,7% vs 16,7%, p), frequency (p=0,018), and dysuria (78,3% vs 16,7%, p). Analysis of the pain questions revealed that 81,3% of the patients in JJ group reported to have pain, and 33,3% in NT group (p), and the JJ group required analgesics more frequently than the NT group (p=0,004). In the NT group 58,8% of the patients required hospital attention at least one time, but only 35,5% in the JJ group, without significance (p=0,070).
Conclusions : This prospective study describes the results related to tolerability and quality of life associated with urinary diversion procedures. The percutaneous nephrostomy seems a safe and well tolerated method with lower influence in quality of life and less associated adverse urinary symptoms when compared with the ureteral stent. More studies with larger are needed for confirm these findings.
Nuno de Sousa Morais– Urology Department, Hospital de Braga, Porto, Porto, Portugal
José Pedro Pereira– School of Medicine University of Minho, Braga, Braga, Portugal
Paulo Mota– Urology Department, Hospital de Braga, Braga, Braga, Portugal
João Nuno Torres– Urology Department, Hospital de Braga, Braga, Braga, Portugal
Agostinho Cordeiro– Urology Department, Hospital de Braga, Braga, Braga, Portugal
Sara Anacleto– Urology Department, Hospital de Braga, Braga, Braga, Portugal
Carlos Oliveira– Urology Department, Hospital de Braga, Braga, Braga, Portugal
Estêvão Lima– Urology Department, Hospital de Braga - CUF, Braga, Braga, Portugal