Comparative Effect of Percutaneous Nephrostomy Versus Double J Ureteral Stenting on Split glomerular filtration rate in Obstructive Uropathy caused by Ipsilateral Urolithiasis

Open Access

Abstract

Background: Obstructive uropathy as a result of  Ipsilateral urolithiasis can cause significant and potentially reversible renal dysfunction. Percutaneous nephrostomy (PCN) and double J ureteral stenting (DJ stent) are commonly used decompressive procedures; however, the comparative effect of these procedures on Split glomerular filtration rate is debated. This study aimed to compare the effects of PCN and DJ stenting on split glomerular filtration rate, serum creatinine, and renal cortical thickness of unilateral obstructive uropathy. Methods & Materials: This quasi-experimental study was carried out at Bangladesh Medical University, Dhaka, Bangladesh, between April 2022 and April 2023. 32 patients with ipsilateral obstructive uropathy due to Ipsilateral urolithiasis were enrolled as adults. Eighteen underwent PCN, while fourteen underwent DJ stenting. Split glomerular filtration rate was measured by 99mTc-DTPA diuretic renography, and serum creatinine and parenchymal thickness were measured preoperatively and 1 month. Data were analyzed on SPSS version 26 with paired and unpaired t-tests at a p<0.05 level of significance. Results: Baseline demographic, clinical, and laboratory parameters were similar. At least for one month, a significant improvement in split GFR was achieved in both groups. In the PCN group, the rise in GFR was from 17.93±3.75 to 24.59±4.28 ml/min/1.73 m2, p<0.001. In the DJ group, it was increased from 17.21±3.87 to 21.94±3.55 ml/min/1.73 m2, p=0.002. Serum creatinine was decreased significantly only in the PCN group, p=0.016. Between-group comparison indicated an increased mean split GFR in the PCN group at one month, but without statistical significance, p=0.071. Conclusion: Both PCN and DJ stenting had a significant beneficial effect on glomerular filtration rate in obstructive uropathy. PCN showed better short-term changes in Split glomerular filtration rate and cortical thickness.