Comparing the percutaneous nephrostomy and hemodialysis in patients with obstructive uropathy.

Document Type : Original Article


1 Urology Resident, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran

2 Department of Urology, Golestan Hospital, Ahvaz University of Medical Sciences, Ahvaz, Iran

3 Fellow in Robotic surgeries and Onco-Urology, Assistant Professor of Urology, Ahvaz Jundishapur


Obstructive uropathy is a disease, which is of great importance to proper treatment. Based on mentioned section aim was to compare the results and complications of percutaneous nephrostomy with hemodialysis in correcting water and electrolyte disorders in patients with obstructive uropathy.
In this as a clinical trial study, thirty patients with obstructive uropathy were considered as study group. Patients were randomly divided into hemodialysis and PCN (percutaneous nephrostomy) groups. In both groups, BUN/Cr, Na, and K were measured every 6 hours. The variables T1 (time to preparation for action), T2 (time to clearance), T3 (total hospitalization time), pain score, satisfaction rate and complications in both groups were compared. Finally, the data were analyzed using SPSS software.
Results show that T1 in both PCN and hemodialysis was not significantly different. However, T2 and T3 in the PCN group had a significant decrease compared to hemodialysis group, also the satisfaction rate in patients with PCN was better than hemodialysis. Concentration of potassium and creatinine in the PCN method decreased more than hemodialysis. However, there was no significant difference in the trend of reduction of other indicators such as sodium concentration, systolic and diastolic blood pressure in both methods.
PCN can be an alternative, appropriate, cheap, and less complicated method for patients with obstructive uropathy.


1-Misseri R, Meldrum DR, Dagher P, Hile K, Rink RC, Meldrum KK. Unilateral ureteral obstruction induces renal tubular cell production of tumor necrosis factor-α independent of inflammatory cell infiltration. The Journal of urology. 2004;172(4):1595-9.
2-Sutherland RW. Obstructive Uropathy.  National Kidney Foundation Primer on Kidney Diseases (Sixth Edition): Elsevier; 2014. p. 397-404.
3-Cutie CJ, McDougal WS. Obstructive Uropathy.  Therapy in Nephrology & Hypertension (Third Edition): Elsevier; 2008. p. 469-75.
4-Regalado SP, editor Emergency percutaneous nephrostomy. Seminars in interventional radiology; 2006: Thieme Medical Publishers.
5-Khan SZ, Fahim F, Mansoor K. Obstructive Uropathy: causes and outcome in pediatric patients. Journal of Postgraduate Medical Institute (Peshawar-Pakistan). 2012;26(2).
6-Sonnenberg H, Wilson D. The role of the medullary collecting ducts in postobstructive diuresis. The Journal of clinical investigation. 1976;57(6):1564-74.
7-Vaughan ED, Marion D, Poppas DP, Felsen D. Pathophysiology of unilateral ureteral obstruction: studies from Charlottesville to New York. The Journal of urology. 2004;172(6):2563-9.
8-Ozok HU, Sagnak L, Senturk AB, Karakoyunlu N, Topaloglu H, Ersoy H. A comparison of metal telescopic dilators and Amplatz dilators for nephrostomy tract dilation in percutaneous nephrolithotomy. Journal of endourology. 2012;26(6):630-4.
9-Docimo SG, Dewolf WC. High failure rate of indwelling ureteral stents in patients with extrinsic obstruction: experience at 2 institutions. The Journal of urology. 1989;142(2):277-9.
10-Vaughan ED, Sweet RE, Gillenwater JY. Unilateral ureteral occlusion: pattern of nephron repair and compensatory response. The Journal of urology. 1973;109(6):979-82.
11-Vaughan Jr AD, Gillenwater JY. Diagnosis, characterization and management of post-obstructive diuresis. The Journal of urology. 1973;109(2):286-92.
12-Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA. Campbell-Walsh urology: expert consult premium edition: enhanced online features and print, 4-volume set: Elsevier Health Sciences; 2011.
13-Allison RP, Belli AM, Chun J-Y, Chung R, Das R, England A, et al. Hemorrhage Following Percutaneous Nephrostomy.  Managing Common Interventional Radiology Complications: Springer; 2014. p. 167-73.
14-Wilson J, Urwin G, Stower M. The role of percutaneous nephrostomy in malignant ureteric obstruction. Annals of the Royal College of Surgeons of England. 2005;87(1):21.
15-Clarkson MR, Brenner BM, Magee C. Pocket Companion to Brenner and Rector's The Kidney E-Book: Elsevier Health Sciences; 2010.
16-Bhangu G, Bansal D, Shah AS, Vyas N, Priyadarshi S, Sharma K. Totally tubeless percutaneous nephrolithotomy: one year single institute prospective study. International Surgery Journal. 2016;4(1):224-8.
17-Kara C, Resorlu B, Bayindir M, Unsal A. A randomized comparison of totally tubeless and standard percutaneous nephrolithotomy in elderly patients. Urology. 2010;76(2):289-93.
18-Karami H, Gholamrezaie HR. Totally tubeless percutaneous nephrolithotomy in selected patients. Journal of endourology. 2004;18(5):475-6.
19-Borges CF, Fregonesi A, Silva DC, Sasse AD. Systematic review and meta-analysis of nephrostomy placement versus tubeless percutaneous nephrolithotomy. Journal of endourology. 2010.
20-Istanbulluoglu MO, Ozturk B, Gonen M, C─▒cek T, Ozkardes H. Effectiveness of totally tubeless percutaneous nephrolithotomy in selected patients: a prospective randomized study. International urology and nephrology. 2009;41(3):541-5.
21-Crook T, Lockyer C, Keoghane S, Walmsley B. A randomized controlled trial of nephrostomy placement versus tubeless percutaneous nephrolithotomy. The Journal of urology. 2008;180(2):612-4.
22-Milicevic S, Bijelic R, Krivokuca V, Bojic M, Popovic-Pejicic S, Bojanic N. Correlation of the Body Mass Index and calcium nephrolithiasis in adult population. medical archives. 2013;67(6):423.