Retrospective Evaluation of the Effects of Ureteral Double-J Stent Placement Versus Percutaneous Nephrostomy on Renal Function and Quality of Life in Patients with Unilateral Acute Obstructive Hydronephrosis Without Renal Failure

<title>Abstract</title> <p>Background There is still controversy regarding the best urinary drainage technique for acute unilateral upper urinary tract obstruction. Our study aims to evaluate the impact of Double-J Stent Placement (DJ) versus Percutaneous Nephrostomy (PCN) on renal function and Health Related Quality Of Life (HRQOL) through the use of MAG-3 Scintigraphy (Functional Endpoint) which has never been used in this manner. Methods Forty two consecutive patients with unilateral hydronephrosis secondary to urolithiasis (n = 32, 76.2%) or malignancy (n = 10, 23.8%) who were treated with DJ stent placement (n = 18, 42.9%) or PCN (n = 24, 57.1%) from December 2014 to December 2016 were retrospectively analyzed. Renal function was evaluated by serum creatinine and MAG-3 renal scintigraphy. Function was determined based upon T½, Tmax, Tmax half-life, and Split Renal Function. HRQL was assessed using the SF-36 Questionnaire (Physical Component Summary [PCS], Mental Component Summary [MCS]) pre and post-procedure. Results Both groups were equivalent at baseline (p &gt; .05 for all demographics/clinical variables). Serum Creatinine levels did not change in either treatment arm. Both treatments resulted in a statistically significant improvement in MAG-3 drainage parameters (T½ &amp; Tmax; p = .001 for each group), without a statistical difference in the degree of improvement. Split Renal Function remained constant in both arms. Colic Frequency decreased significantly in the DJ group when compared to the PCN Group (p = .008). Only the DJ stent group experienced a statistically significant improvement in PCS (Pre – Post 73.89 ± 3.14 vs. 77.78 ± 5.37; p = .02). Although there was a trend towards increased PCS in the PCN group, it was not statistically significant (Pre – Post 72.69 ± 3.36 vs. 76.68 ± 5.55; p = .723). There was also a statistically significant increase in MCS in the DJ Group (p = .015). Conclusions Both DJ stent placement and PCN provided adequate relief of upper urinary tract obstruction, providing similar results concerning renal functional outcomes (as evidenced by MAG-3 scintigraphy and serum creatinine). DJ stent placement resulted in a significant improvement in physical and mental HRQL and better pain control than PCN, whereas PCN did not result in a statistically significant improvement in HRQL. Routine addition of MAG-3 scintigraphy provides an objective measure of obstruction relief that cannot be achieved via measurement of serum creatinine.</p>