Patient-reported outcome measures of percutaneous nephrostomy vs JJ stent in obstructive urolithiasis: results of the STent Or NEphrostomy (STONE) randomised controlled trial.

Abstract

To compare the effects of percutaneous nephrostomy (PCN) and JJ ureteric stent (JJ) for urinary tract decompression in patients with obstructive urolithiasis on health-related quality of life (HRQoL), pain scores, urinary symptoms, and patient satisfaction. In 11 hospitals, 204 patients with obstructive urolithiasis were randomised to JJ or PCN placement. Patient-reported outcome measures (PROMs) were assessed until stone passage, surgical removal, or at 3 months. Both PCN and JJ effectively improved HRQoL index scores (PCN: pre-decompression 0.70, 1 day post-decompression 0.82, P = 0.003; JJ: pre 0.59, post 0.85, P < 0.001), pain scores (PCN: pre 4.9, post 1.3, P < 0.001; JJ: pre 5.5, post 1.3, P < 0.001), and achieved patient satisfaction (score at discharge PCN: 7.9; JJ: 8.2), with no significant differences between interventions in overall HRQoL (generalised estimating equation [GEE] P = 0.7) or mean daily pain scores (GEE P = 0.4). PCN led to more self-care difficulties (patients reporting no problems: PCN 74%, JJ 91%, P = 0.023), while JJ recipients reported more urinary symptoms and higher peak pain intensity (pain score PCN: 2.3, JJ: 3.7, between groups P = 0.018). Despite symptoms, more JJ recipients preferred the same intervention in future (60%), than PCN recipients (31%) (P < 0.001). Survey-based data collection may introduce response bias (response rate 59%). In patients with obstructive urolithiasis, urinary decompression with PCN and JJ improved HRQoL and pain comparably. JJ causes more urinary symptoms and peak pain but allows better self-care. Baseline self-care and urinary symptoms should guide shared decision-making. Drainage duration should be minimised.