Nephrostomy Tube or ‘JJ’ Ureteric Stent in Ureteric Obstruction: Assessment of Patient Perspectives Using Quality–of–Life Survey and Utility Analysis

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Abstract
Introduction: Upper urinary tract obstruction is often relieved by either a percutaneous nephrostomy tube (PCN) or a ureteric stent. Both can cause considerable morbidity and reduce patient’s health–related quality of life (QoL). We have compared the QoL in these 2 groups. Patients and Methods: 34 patients (21 stent and 13 PCN) with unilateral ureteric obstruction were prospectively studied. Each patient completed a questionnaire, which included a common single health index (EuroQol EQ–5D) and intervention–specific questions to assess pain, urinary symptoms and day–to–day problems. Results: There were 22 male and 12 female patients [mean age 56±9 years (PCN) and 55±14 years (stent)]. The mean duration between the intervention and conduct of the survey was 12±5 days for PCN and 28±14 days for stent. There was no different in the mean EuroQol score (p = 0.199) and analogue score (p = 0.596) indicating no differences in the gross defects in physical and psychosocial function and the utility between the 2 groups. There was a significant difference in the urinary symptoms (p<0.0001) with patients who had a stent experiencing significantly more irritative urinary symptoms. This group also suffered discomfort for a greater duration and in various postures requiring more analgesia (although not significant with Bonferroni correction). Patients with PCN required more help in the daily care of the nephrostomy tube. There was no difference in the incidence of infections and the need for antibiotics. Conclusions: Patients with ‘JJ’ stents have significantly more irritative urinary symptoms and a high chance of local discomfort than patients with nephrostomy tubes (PCN). However, based on the EuroQol analysis, there is no significant difference in the gross impact on the health–related QoL or the utility between these groups indicating no patient preference for either modality of treatment.