Outcomes of nephrostomy and double J stent in malignant ureteral obstruction in the Palestinian practice

Malignant ureteral obstruction (MUO) is a serious condition in which a malignant tumor compresses the ureter. The optimal decompressive intervention for MUO remains unclear. This study was conducted to assess and compare renal function, the occurrence of ureterohydronephrosis (UHN), intraoperative, and postoperative complications among patients with MUO who underwent double J stenting (DJS) and percutaneous nephrostomy (PCN) in clinical practice in Palestine.

This study was conducted using a retrospective design at one of the main tertiary care hospitals in the West Bank of Palestine. The data were collected from the electronic health information system of the hospital for the patients with MUO who received either DJS or PCN as a decompressive intervention from January 2018 to January 2024.

In this retrospective analysis, 62 patients who had stage 2 to stage 4 cancer and suffered MUO were included. The mean age of the patients was 60.8 ± 13.6 years. Of the patients, 40 (64.5%) were male and 22 (35.5%) were female. Of the patients, 26 (41.9%) had urinary bladder cancer. Of the patients, 23 (37.1%) had flank pain and 16 (25.8%) had lower urinary tract symptoms. Of the patients, 34 (54.8%) experienced bilateral UHN and 28 (45.2%) experienced unilateral UHN. In this study, 43 patients (69.4%) received PCN, and 19 (30.6%) received DJS as a decompressive intervention. Of the patients, 36 (58.1%) suffered postoperative complications. Stent migration/slip, UTIs, and urosepsis were the most commonly reported postoperative complications. There were no statistically significant differences in the occurrence of intraoperative complications, postoperative complications, time elapsed from receiving the decompression intervention to the diagnosis of complications, ICU admission, prognosis of UHN, serum creatinine, and serum BUN between both decompressive interventions.

Renal function improved following intervention, although creatinine and BUN levels often remained abnormal, and postoperative complications were common. No statistically significant differences were observed between the two procedures; however, these findings should be interpreted with caution given the small sample size, baseline imbalances, and lack of multivariable adjustment. Larger multicenter prospective studies with standardized benchmarks, survival, and quality‑of‑life outcomes are needed to more reliably determine the comparative effectiveness of DJS and PCN.