Comparing outcomes of ureteric stent versus nephrostomy tube in urosepsis: a population-based study in Ontario, Canada

Purpose — Urolithiasis is a common cause of obstruction and sepsis requiring urgent urinary diversion via nephrostomy tubes (NT) or ureteric stents. This study compares all-cause mortality between patients treated with NT versus ureteric stents for urosepsis secondary to urolithiasis, both during hospitalization and within 90 days post-discharge.

Methods — We conducted a retrospective cohort study of adult patients hospitalized in Ontario, Canada, between April 2010 and December 2022, with an admitting diagnosis of urosepsis secondary to obstructive urolithiasis. Exclusion criteria included sepsis without concurrent urolithiasis, prior dialysis, end-stage renal disease, transplant, cystectomy, or genitourinary cancers. We used generalized linear and Cox regression models to compare all-cause mortality between NT and ureteric stent groups, applying inverse probability of treatment weighting (IPTW) to reduce selection bias. Our 90-day analysis also assessed the impact of definitive management following hospitalization.

Results — Among 4,573 patients, 620 underwent NT placement, and 3,953 received a ureteric stent. After adjusting for confounders, NT placement was associated with a 2.84-fold higher in-hospital mortality risk (RR: 2.84 [1.98, 3.92]) and a 1.52-fold higher 90-day mortality risk (HR: 1.52 [1.01, 2.30]). Furthermore, definitive management significantly reduced 90-day mortality risk by 62% (HR: 0.38 [0.23, 0.63]).

Conclusion — While both interventions aim to relieve obstruction and facilitate resolution of infection, NT placement is linked to higher in-hospital and 90-day mortality. These findings highlight the importance of treatment selection in optimizing patient outcomes.