The Efficacy And Safety Of Percutaneous Nephrostomy And Retrograde Ureteral Stenting For Upper Urinary Tract Calculous Obstruction Complicated With Infection :a Meta-analysis

Objective: To study the clinical efficacy and safety of percutaneous nephrostomy(PCN)and retrograde ureteral stenting(RUS)in the treatment of upper urinary tract calculous obstruction complicated with infection.Methods: The Cochrane Library,Pubmed,Web of Science,Embase and other foreign databases were searched by computer,as well as Chinese databases such as CNKI,CQVIP,CBM and Wanfang.The literature was collected from January 2000 to January 2022 on percutaneous nephrostomy(PCN)and retrograde ureteral stenting(RUS)for the treatment of upper urinary tract calculous obstruction with infection.The quality of the included literature was evaluated,relevant data were extracted,and meta-analysis was performed using Rev Man 5.3 software.Results: A total of 10 literatures were included in this study,including 7 randomized controlled studies,3 cohort studies,3 Chinese literatures and 7 foreign literatures.The baseline data of the included literatures were not statistically significant.There were 430 cases in the experimental group(PCN group)and 666 cases in the control group(RUS group).Meta-analysis showed that there were no distinct differences in length of hospital stay(P=0.48)and spontaneous stone passing rate(P=0.25)between the PCN group and the RUS group(P > 0.05).In EQ-5D,there were little evident differences in pain/discomfort(P=0.31)and anxiety/depression(P=0.10)between the PCN group and the RUS group.There were statistically significant differences in self-care(P=0.0005),usual activity(P=0.001),and the health score of the PCN group was lower than that of the RUS group.Compared with RUS group,PCN group had higher mobility(P=0.03),normalization time of hemameba(P=0.002),normalization time of body temperature(P=0.0007),incidence of macroscopic hematuria(P=0.0002),dysuria(P < 0.00001),frequency of urination(P=0.0003)and operation success rate(P=0.0003).P=0.0004),the difference was statistically significant(P <0.05),and the clinical effect of PCN group was better than that of RUS group.Conclusions: Compared with retrograde ureteral stenting,percutaneous nephrostomy can lower inflammatory markers and restore normal body temperature more quickly in studies of upper urinary tract calculous obstruction with infection.The PCN group was better tolerated with less stimulation for lower urinary tract symptoms.On the The Euro Qol-5 Dimension(EQ-5D),the PCN group was worse than the RUS group in terms of self-care and usual activity,better than the RUS group in terms of mobility,and comparable in terms of pain/discomfort and anxiety/depression.In terms of length of hospital stay,there was no significant difference between the PCN and RUS groups.Therefore,PCN is a more recommended method of renal pelvis decompression in terms of infection control and quality of life in the lower urinary tract.