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JJ Stent or Nephrostomy for Septic Obstructing Stones? Nationwide Long-term Outcomes from Iceland, 2013-2023.
Edward Rumba, MD., Jóhann P. Ingimarsson, MD..
University of Iceland, Reykjavík, Iceland.
Background: Long-term mortality and readmission outcomes after urgent decompression of infected obstructing stones are under-described. We compared double-J (JJ) ureteral stents and percutaneous nephrostomy (PCN) in patients meeting systemic inflammatory response syndrome (SIRS) criteria due to obstructing urolithiasis with regards to readmissions and mortality over a 5-year follow-up.
Methods: Manual chart review of all 1,595 decompressions for stones performed at all Icelandic hospitals from 2013-2023 identified 231 SIRS cases (JJ=130; PCN=101). Group comparisons used t/Wilcoxon or Fisher exact tests. Logistic regression modeled odds of JJ vs PCN. Five-year survival was evaluated using unadjusted Kaplan-Meier (KM) and Cox proportional hazards models adjusted for age, stone size, and time to operation (days from presentation to decompression). Adjusted Cox curves were standardized over covariates.
Results: PCN patients were older (60.8 vs 54.7 y, p=0.012), more febrile (38.7 vs 38.4 °C, p=0.011), tachypneic (22.4 vs 20.0/min, p=0.003), had larger stones (10.1 vs 7.5 mm, p<0.001), and shorter time to decompression (0.7 vs 1.1 d, p<0.001). Short-term outcomes were comparable, length of stay 5.5 vs 4.7 d (p=0.073), ICU admission 16.8% vs 13.8% (p=0.530). Urine cultures taken before decompression were more often positive in PCN (70.3% vs 44.6%, p<0.001). Bacteremia rates were similar (37.6% vs 30.8%, p=0.275), but
Escherichia coli accounted for a greater proportion of bacteremias
in PCN cases
(79.4% vs 42.9%, p=0.002). Neither KM nor adjusted Cox analyses showed 5-year differences in mortality HR 0.49 [0.20-1.17], all-cause HR 0.98 [0.68-1.43], or stone related HR 0.84 [0.51-1.37]).
Conclusions: PCN was used in older and more acutely ill patients, leading to faster decompression. Despite this, both unadjusted and adjusted analyses showed comparable short- and long-term outcomes, supporting JJ and PCN as comparably effective decompression strategies for septic obstructing stones.
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