Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia.
Hospital Universiti Sains Malaysia, Universiti Sains Malaysia Health Campus, Jalan Raja Perempuan Zainab 2, 16150, Kota Bharu, Kelantan, Malaysia.
Sci Rep. 2021 Mar 23;11(1):6613. doi: 10.1038/s41598-021-86136-y.
Acute obstructive uropathy is associated with significant morbidity among patients with any condition that leads to urinary tract obstruction. Immediate urinary diversion is necessary to prevent further damage to the kidneys. In many centres, the two main treatment options include percutaneous nephrostomy (PCN) and retrograde ureteral stenting (RUS). The purpose of this study if to compare the efficacy and safety of PCN and RUS for the treatment of acute obstructive uropathy. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL, EMBASE, the World Health Organisation International Clinical Trials Registry Platform and ClinicalTrials.gov. We also searched the reference lists of included studies to identify any additional trials. We included randomised controlled trials and controlled clinical trials comparing the outcomes of clinical improvement (septic parameters), hospitalisation duration, quality of life, urinary-related symptoms, failure rates, post-procedural pain [measured using a visual analogue scale (VAS)] and analgesics use. We conducted statistical analyses using random effects models and expressed the results as risk ratio (RR) and risk difference (RD) for dichotomous outcomes and mean difference (MD) for continuous outcomes, with 95% confidence intervals (CIs). Seven trials were identified that included 667 patients. Meta-analysis of the data revealed no difference in the two methods in improvement of septic parameters, quality of life, failure rates, post-procedural pain (VAS), or analgesics use. Patients receiving PCN had lower rates of haematuria and dysuria post-operatively and longer hospitalisation duration than those receiving RUS. PCN and RUS are effective for the decompression of an obstructed urinary system, with no significant difference in most outcomes. However, PCN is preferable to RUS because of its reduced impact on the patient's post-operative quality of life due to haematuria and dysuria, although it is associated with slightly longer hospitalisation duration.
急性梗阻性尿路病与任何导致尿路梗阻的疾病患者的发病率显著相关。为了防止肾脏进一步受损，需要立即进行尿路引流。在许多中心，两种主要的治疗选择包括经皮肾造口术 (PCN) 和逆行输尿管支架置入术 (RUS)。本研究旨在比较 PCN 和 RUS 治疗急性梗阻性尿路病的疗效和安全性。我们检索了 Cochrane 对照试验中心注册库 (CENTRAL)、MEDLINE、CINAHL、EMBASE、世界卫生组织国际临床试验注册平台和 ClinicalTrials.gov。我们还检索了纳入研究的参考文献列表，以确定任何其他试验。我们纳入了比较临床改善（感染参数）、住院时间、生活质量、与尿相关的症状、失败率、术后疼痛（使用视觉模拟量表 (VAS) 测量）和镇痛药物使用的随机对照试验和对照临床试验。我们使用随机效应模型进行统计分析，结果表示为二分类结局的风险比 (RR) 和风险差 (RD)，连续结局的均数差 (MD)，置信区间 (CI) 为 95%。确定了 7 项试验，共纳入 667 名患者。对数据的荟萃分析显示，两种方法在改善感染参数、生活质量、失败率、术后疼痛 (VAS) 或镇痛药物使用方面没有差异。与接受 RUS 的患者相比，接受 PCN 的患者术后血尿和尿痛发生率较低，住院时间较长。PCN 和 RUS 均可有效解除梗阻性泌尿系统的压力，大多数结局无显著差异。然而，由于血尿和尿痛对患者术后生活质量的影响较小，PCN 优于 RUS，尽管它与住院时间稍长有关。
