Effect of initial drainage method on retrograde intrarenal surgery outcomes in acute calcular pyelonephritis: a prospective comparative study

This prospective study compared percutaneous nephrostomy (PCN) and double-J (DJ) stent drainage in 200 patients presenting with acute calcular pyelonephritis due to a single upper urinary tract stone ≤ 2 cm. Patients were randomized into two equal groups; PCN was performed under local anesthesia with ultrasound guidance, while DJ stenting was carried out under spinal anesthesia, and definitive retrograde intrarenal surgery (RIRS) was scheduled two weeks after drainage. Clinical recovery, operative parameters, postoperative complications, stone-free rates, and quality of life were assessed. Baseline demographic data and stone characteristics were comparable between groups. PCN achieved significantly faster normalization of temperature (3.5 ± 0.7 vs. 6 ± 1.4 h, p < 0.0001), earlier leukocyte count recovery (2.5 ± 0.6 vs. 3.5 ± 0.6 days, p < 0.0001), and shorter hospitalization (2.5 ± 0.6 vs. 3.5 ± 0.6 days, p < 0.0001). RIRS following PCN showed shorter operative time (55.1 ± 5.9 vs. 71.5 ± 3.2 min, p < 0.0001) and a lower rate of postoperative fever (5% vs. 20%, p = 0.002), while stone-free rates were similar (96% vs. 93%, p = 0.072). These findings suggest that PCN provides faster sepsis resolution and more favorable perioperative outcomes compared with DJ stenting, although both approaches allow successful subsequent RIRS.