ORIGINALARTICLE

TO COMPARE THE EFFECTIVENESS OF PERCUTANEOUS NEPHROSTOMY VERSUS DOUBLE-J

STENT IN OBSTRUCTIVE UROPATHY

Ishtiaq Ur Rehman¹, Murad Ali², Adil Muhammad², Muhammad Danish², Asghar Ali²,

Syed Abdul Basit Ali Shah², Pir Sabir Shah²

How to cite this article

ABSTRACT

OBJECTIVES

Rehman IU, Ali M, Muhammad A,

Danish M, Ali A, Shah SABA, et. al.

To Compare the Eectiveness of

Percutaneous Nephrostomy Versus

Double-J Stent in Obstructive

Uropathy. J Gandhara Med Dent Sci.

2026;13(2):65-70

https://doi.org/10.37762/jgmds.13-2.847

This study aimed to compare the short-term eectiveness of percutaneous

nephrostomy and double-J ureteral stenting in patients with obstructive

uropathy.

METHODOLOGY

This retrospective observational study was conducted at Rehman Medical

Institute, Peshawar, from January to December 2024. All positive blood

cultures during the study period were processed using standard

microbiological techniques and the Vitek 2.0 system. Antimicrobial

susceptibility testing was performed according to Clinical and Laboratory

Standards Institute (CLSI) and European Committee on Antimicrobial

Susceptibility Testing (EUCAST) 2024 guidelines. Organisms were

categorized as per standard resistance classication. Data were analyzed in

SPSS v27, with p<0.05 considered signicant.

Date of Submission: 07-01-2026

Date Revised:

Date Acceptance:

13-03-2026

14-03-2026

¹Senior Registrar, Department of

Urology, Khyber Teaching Hospital,

Peshawar

RESULTS

Mean age was 35.6 ± 8.4 years, and 76.7% of participants were male.

Treatment eectiveness was higher with percutaneous nephrostomy than with

double-J stenting (88.5% vs 77.9%, p = 0.004). After adjustment,

percutaneous nephrostomy remained associated with higher odds of success

(adjusted odds ratio 2.05, 95% condence interval 1.18 to 3.55, p = 0.01).

Female sex and malignant etiology were independently associated with lower

treatment success. Procedure time and hospital stay were similar between

groups.

Correspondence

²Murad Ali, Post Graduate Resident,

Department of Urology, Khyber

Teaching Hospital, Peshawar

+92-345-9484886

CONCLUSION

muradalik46@gmail.com

Percutaneous nephrostomy was associated with higher short-term treatment

eectiveness than double-J stenting in obstructive uropathy. Clinical context

and underlying etiology should guide treatment selection.

KEYWORDS: Obstructive Uropathy, Percutaneous Nephrostomy, Double -J

Stent, Prospective Cohort, Urinary Drainage, Eectiveness.

INTRODUCTION

for upper urinary tract decompression are retrograde

double-J

ureteral

stenting

and

percutaneous

nephrostomy.⁵Double-J stenting provides internal

drainage and avoids the need for an external appliance,

but it may be associated with irritative lower urinary

tract symptoms, hematuria, migration, and later

encrustation.⁶Percutaneous nephrostomy provides

direct and reliable external drainage and is particularly

useful when retrograde access is dicult or has failed.

Its disadvantages include the need for an external

drainage system, risk of tube dislodgement, and local

site-related complications.⁷Current guidelines accept

both approaches, and the choice between them depends

on the patient's condition, the underlying cause of

obstruction, anatomical feasibility, local expertise, and

procedural availability.⁸Previous comparative studies

have reported mixed ndings. Some have shown higher

technical or clinical success with percutaneous

Obstructive uropathy is a common condition in

urological practice and an important reversible cause of

acute kidney injury. Obstruction to urinary ow

increases pressure within the collecting system, leading

to hydronephrosis and, if untreated, progressive renal

impairment. Patients commonly present with ank pain,

fever, or uremic symptoms, and delayed treatment may

result in urosepsis or irreversible loss of renal

function.^1,2The etiology of obstructive uropathy is

diverse and includes ureteric calculi, ureteral strictures,

benign prostatic enlargement, retroperitoneal brosis,

and extrinsic compression from pelvic or abdominal

malignancy.³In the local setting, urolithiasis remains a

major cause of obstruction and contributes substantially

to the acute urological workload.⁴Because timely

decompression is essential, prompt diversion of the

obstructed urinary system remains a key component of nephrostomy, particularly in complex or malignant

management. The two most commonly used methods obstruction, whereas others have emphasized the less

April - June 2026

J Gandhara Med Dent Sci

To Compare the Eectiveness of Percutaneous Nephrostomy

invasive nature and greater comfort of internal signicant bleeding, or painful trigonal irritation.

stenting.^9,10Prospective data from South Asian Successful decompression was assessed clinically and

populations remain limited despite dierences in case by documented relief of obstruction after the index

mix, stone burden, and resource availability. This procedure. Procedural failure included the inability to

prospective cohort study was conducted at a tertiary place the intended drainage device or the need for

care center to compare the short-term eectiveness of immediate alternative diversion. The study protocol

percutaneous nephrostomy and double-J stenting in was approved by the Institutional Research and Ethical

patients with obstructive uropathy and to evaluate Review Board of Khyber Medical College/Khyber

which approach provides more reliable early Teaching Hospital on April 18, 2025. Written informed

decompression in routine clinical practice.

consent was obtained from all participants, and patient

confidentiality was maintained throughout the study.

Patients were screened in the outpatient and emergency

departments. Baseline data were recorded on

structured proforma, including age, sex, side of

obstruction, clinical presentation, and relevant

METHODOLOGY

This prospective cohort study was conducted in the

Department of Urology, Khyber Teaching Hospital,

Peshawar, from April 23, 2025, to December 2025.

Patients with newly diagnosed obstructive uropathy

were enrolled during the study period. As treatment

selection was based on clinical decision-making rather

than random allocation, the study design was

observational. The sample size was calculated to detect

examination ndings.¹¹Laboratory evaluation included

complete blood count, renal function tests, urine

analysis, coagulation prole, and viral markers.

Ultrasonography was used to conrm hydronephrosis

and the aected side. The underlying etiology of

obstruction, infection status at presentation, and grade

of hydronephrosis were recorded from the clinical and

imaging assessment, where available in the patient

record. In the double-J stent group, patients underwent

retrograde ureteral stent placement under cystoscopic

guidance using a 5 to 6 Fr stent. Local anesthesia with

2% lignocaine gel, with or without mild sedation, was

clinically meaningful dierence in treatment

effectiveness between the two procedures. Assuming

percutaneous nephrostomy eectiveness of 92% and

double-J stenting eectiveness of 83%, with 80%

power and a two-sided alpha of 0.05, the required

sample size was 416 patients, with 208 patients per

group.¹¹Consecutive non-probability sampling was

used. All eligible patients presenting during the study

period were considered for inclusion until the required

sample size was achieved. Patients were allocated to

either the percutaneous nephrostomy or the double-J

stent group based on the treating urologist's clinical

judgment, anatomical feasibility, and procedural

suitability. The age between 20 and 80 years and newly

used

according

procedural

requirements.

Prophylactic intravenous antibiotics were administered,

and a Foley catheter was retained for 48 hours when

indicated. In the percutaneous nephrostomy group,

patients underwent ultrasound-guided placement of an 8

Fr nephrostomy tube in the prone position under local

inltration with 1% lignocaine. The tube was connected

to an external drainage bag. Peri-procedural antibiotics

were administered according to unit protocol. All

patients were followed for 15 days after the index

procedure. During follow-up, treatment eectiveness

and early complications were recorded, including

procedural failure, septicemia, signicant bleeding, and

painful trigonal irritation. Data were analyzed using

SPSS version 22. Continuous variables, including age,

procedure duration, and hospital stay, were expressed

as mean ± standard deviation. Categorical variables,

including sex, side of obstruction, and treatment

effectiveness, were presented as frequencies and

percentages. Group comparisons were performed using

the independent-samples t-test for continuous variables

and the chi-square test for categorical variables.

Multivariable logistic regression was performed to

adjust for potential confounding. The primary outcome

variable was treatment success at 15 days. The

treatment group was the main predictor variable.

Covariates included age, sex, etiology of obstruction,

diagnosed

obstructive

uropathy

conrmed

ultrasonography and ank pain with a visual analog

scale (VAS) score greater than 5 were included. The

Prior surgical or endoscopic intervention for the current

obstructive

episode,

Severe

uncorrected

coagulopathy, Uremia secondary to bladder outlet

obstruction as the primary cause, and Bladder outlet

obstruction

from

benign

prostatic

hyperplasia.

Operational denitions included: Obstructive Uropathy:

Defined as a structural or functional obstruction to

urinary ow with hydronephrosis conrmed on

ultrasonography. Percutaneous Nephrostomy (PCN):

Ultrasound-guided placement of an 8 Fr nephrostomy

tube into the renal pelvis for external drainage. Double-

J (DJ) Stent: Cystoscopic-guided retrograde placement

of a ureteral stent. Stent size was 5 or 6 Fr.

Polyurethane stents were used. Local anesthesia with

2% lignocaine gel was administered. Treatment

eectiveness: Successful decompression at 15-day

follow-up without procedural failure, septicemia, hydronephrosis grade, pre-operative urine culture

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To Compare the Eectiveness of Percutaneous Nephrostomy

Table 1: Baseline Demographic and Clinical Characteristics

status, and baseline serum creatinine. These variables

Characteristic

PCN (n =

208)

DJ Stent (n = p-

were selected based on clinical relevance and prior

literature. Results are presented as adjusted odds ratios

with 95% condence intervals. Model calibration was

assessed using the Hosmer-Lemeshow test, and

discriminatory ability was evaluated by the area under

the receiver operating characteristic curve. An

interaction term between treatment and sex was tested

to assess eect modication. A p-value less than 0.05

was considered statistically signicant. Stratied

analyses by age, sex, and side of obstruction were also

performed.

208)

36.1 ± 9.1

value

0.281

Age, years, mean ±

35.2 ± 7.7

Sex, n (%)

Male

Female

0.202

154 (74.0)

54 (26.0)

165 (79.3)

43 (20.7)

Etiology of obstruction, n (%)

0.41

Stone

Stricture

Malignant

153 (73.6)

26 (12.5)

29 (13.9)

160 (76.9)

28 (13.5)

20 (9.6)

Side of obstruction, n (%)

Left

Right

0.623

0.55

101 (48.6)

107 (51.4)

96 (46.2)

112 (53.8)

RESULTS

Hydronephrosis grade, n (%)

total of 416 patients with newly diagnosed

Grade I/II

Grade III

Positive pre-op urine

culture, n (%)

Serum creatinine,

mg/dL, mean ± SD

Procedure duration,

min, mean ± SD

Hospital stay, days,

mean ± SD

109 (52.4)

99 (47.6)

48 (23.1)

115 (55.3)

93 (44.7)

36 (17.3)

obstructive uropathy were enrolled during the study

period. Of these, 208 underwent percutaneous

nephrostomy and 208 underwent double-J stenting. All

patients completed the 15-day follow-up, and no loss to

follow-up was recorded. Participant ow is shown in

Figure 1.

0.14

1.5 ± 0.7

26.3 ± 6.4

3.0 ± 1.6

1.4 ± 0.6

27.0 ± 6.6

3.1 ± 1.4

0.31

0.259

0.515

At 15-day follow-up, treatment success was achieved in

184 of 208 patients (88.5%) in the percutaneous

nephrostomy group and in 162 of 208 patients (77.9%)

in the double-J stent group. This dierence was

statistically signicant (p = 0.004). The crude odds

ratio for treatment success with percutaneous

nephrostomy compared with double-J stenting was 2.18

(95% confidence interval 1.27 to 3.72).

Figure 1: Cohort Flow Diagram of Patient Inclusion, Allocation

to Intervention, and Follow-Up

Baseline demographic and clinical characteristics are

presented in Table 1. The mean age of the study

population was 35.6 ± 8.4 years, and 76.7% of

participants were male. The percutaneous nephrostomy

and double-J stent groups were comparable with respect

to age, sex distribution, etiology of obstruction, side of

obstruction, hydronephrosis grade, pre-operative urine

culture status, and baseline serum creatinine. Mean

procedure duration and mean hospital stay were also

similar between groups, with no statistically signicant

dierences observed for any baseline or peri-procedural

variable.

Figure 2: Comparison of treatment eectiveness between PCN

and DJ stent groups

Mean procedure duration did not dier signicantly

between the two groups (26.3 ± 6.4 minutes for

April - June 2026

J Gandhara Med Dent Sci

To Compare the Eectiveness of Percutaneous Nephrostomy

Table 3: Multivariable Logistic Regression Analysis of Factors

percutaneous nephrostomy versus 27.0 ± 6.6 minutes

for double-J stenting; p = 0.259). Mean hospital stay

was also similar (3.0 ± 1.6 days versus 3.1 ± 1.4 days; p

= 0.515). Stratied analysis by sex is presented in Table

2. Among male patients, treatment success was 136 of

154 (88.3%) in the percutaneous nephrostomy group

and 145 of 165 (87.9%) in the double-J stent group,

with no signicant dierence between groups (p =

0.905). Among female patients, treatment success was

48 of 54 (88.9%) in the percutaneous nephrostomy

group compared with 17 of 43 (39.5%) in the double-J

stent group (p < 0.001). Among women who underwent

double-J stenting and did not achieve treatment success,

the reported causes included procedural failure due to

inability to pass the guidewire in 16 patients, persistent

painful trigonal irritation in 8 patients, and septic

deterioration in 2 patients.

Associated with Treatment Success

Variable

Treatment group

DJ Stent

PCN

aOR

95% CI

p-value

Reference

2.05

1.18 - 3.55

0.96 - 1.02

0.01

0.48

Age (per year)

Sex

0.99

Male

Female

Etiology

Stone

Stricture

Malignant

Reference

0.41

0.005

0.22 - 0.76

Reference

0.72

0.38

0.38 - 1.36

0.17 - 0.85

0.31

0.02

Hydronephrosis grade

Grade I/II

Grade III

Reference

0.83

0.45

0.51 - 1.35

Pre-op urine culture

Negative

Reference

0.68

0.87

Positive

0.39 - 1.19

0.58 - 1.31

0.18

0.51

Baseline serum

creatinine (per

mg/dL)

Table 2: Stratied Analysis of Treatment Eectiveness

Subgroup PCN

Eective

DJ Stent

Eective/

Total (%)

P-

Value

Crude

(95%

CI)

aOR = adjusted odds ratio; CI = condence interval,

Model t: Hosmer–Lemeshow χ² = 6.84, p = 0.55; area

under ROC curve = 0.78 (95% CI 0.72–0.84) A formal

test for interaction between treatment group and sex

was statistically signicant (p for interaction = 0.01),

indicating that the association between treatment type

and treatment success diered by sex. This nding was

consistent with the stratied analysis.

/Total (%)

Male

136/154

(88.3)

145/165

(87.9)

0.905

1.04

(0.53–

2.05)

12.24

(4.30–

34.82)

Female

48/54

(88.9)

17/43 (39.5)

<0.001

Multivariable logistic regression was performed to

account for potential confounding. After adjustment for

age, sex, etiology of obstruction, hydronephrosis grade,

pre-operative urine culture status, and baseline serum

DISCUSSION

This prospective cohort study found higher short-term

treatment success with percutaneous nephrostomy than

with double-J stenting in patients with obstructive

uropathy. This dierence remained signicant after

adjustment for measured confounders. Female sex and

malignant etiology were independently associated with

lower treatment success. A signicant interaction

between treatment type and sex was also observed. The

main nding of this study was the higher eectiveness

of percutaneous nephrostomy at 15 days. Success was

achieved in 88.5% of patients in the percutaneous

nephrostomy group and 77.9% in the double-J stent

group. The adjusted analysis showed a similar eect

size. This supports the stability of the observed

association. These ndings are in line with previous

comparative studies and systematic reviews that

reported higher procedural success with percutaneous

creatinine,

percutaneous

nephrostomy

remained

independently associated with higher treatment success

than double-J stenting (adjusted odds ratio 2.05, 95%

confidence interval 1.18 to 3.55; p = 0.01). Female sex

was independently associated with lower treatment

success (adjusted odds ratio 0.41, 95% condence

interval 0.22 to 0.76; p = 0.005), as was malignant

etiology compared with stone disease (adjusted odds

ratio 0.38, 95% condence interval 0.17 to 0.85; p =

0.02). Stricture etiology showed a non-significant trend

toward lower treatment success. Age, high-grade

hydronephrosis, positive pre-operative urine culture,

and baseline serum creatinine were not signicantly

associated with treatment success in the adjusted model.

The full multivariable model is presented in Table 3

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To Compare the Eectiveness of Percutaneous Nephrostomy

nephrostomy in selected settings.^12,13,14Published

so sex-specic ndings should be interpreted cautiously

and conrmed in larger studies. The study also has

clear strengths. It used a prospective cohort design. The

sample size was adequate. Follow-up was complete.

The analysis included adjustment for important clinical

variables. Interaction testing added depth to the

interpretation of subgroup ndings. The study also

addresses a regional evidence gap in the comparative

management of obstructive uropathy.

reviews

have

also

may

shown

that

percutaneous

reliable

nephrostomy

provide

decompression, especially in technically dicult

cases.¹⁵An important nding was the dierence

observed by sex. In male patients, treatment success

was similar in the two groups. In female patients,

treatment success was much lower with double-J

stenting than with percutaneous nephrostomy. The

significant interaction test supported this pattern. The

result should be interpreted with care, but it remains

clinically important. In women who underwent double-

J stenting, failure was mainly related to inability to pass

the guidewire, persistent trigonal irritation, and septic

deterioration. Previous reports have also suggested that

retrograde stenting may be less successful in selected

patients with malignant or pelvic obstruction.^15,17

Malignant etiology was also associated with lower

treatment success. This is clinically plausible. Extrinsic

compression may reduce the chance of successful

retrograde stent placement and eective drainage. In

such cases, percutaneous nephrostomy may oer a

more dependable route of decompression because it

bypasses the obstructed ureter.¹⁷Stricture etiology

showed the same direction of eect but did not reach

statistical signicance in the adjusted model. Procedure

duration and hospital stay were similar in both groups.

These ndings suggest that the higher eectiveness of

percutaneous nephrostomy was not oset by longer

procedure time or longer hospitalization in this cohort.

The regression model also performed well, with

adequate calibration and fair discrimination. This

supports the internal consistency of the adjusted

analysis. The present ndings are relevant to routine

practice in resource-limited settings. In many centers,

treatment choice is inuenced not only by anatomy and

etiology but also by operator judgment and available

equipment. The results suggest that percutaneous

nephrostomy may be the more reliable initial option

when retrograde access is expected to be dicult or

when malignant obstruction is suspected. At the same

time, eectiveness is only one part of decision-making.

Patient comfort and quality of life were not measured in

this study. This remains important because some

patients may still prefer internal drainage despite a

lower technical success rate.¹⁸

CONCLUSIONS

Percutaneous nephrostomy was associated with higher

short-term treatment eectiveness than double-J

stenting in obstructive uropathy. Lower treatment

success was observed in female patients and in

malignant obstruction. Percutaneous nephrostomy may

oer more reliable decompression in selected patients,

but these ndings should be interpreted cautiously

because of the non-randomized design.

CONFLICT OF INTEREST: None

FUNDING SOURCES: None

REFERENCES

1. Pérez-Aizpurua X, Cabello Benavente R, Bueno Serrano G,

Alcázar Peral JM, Gómez-Jordana Mañas B, Tufet i Jaumot J, et

al. Obstructive uropathy: overview of the pathogenesis, etiology

and management of a prevalent cause of acute kidney injury.

World

Nephrol.

2024;13(2):93322.

https://doi.org/10.5527/wjn.v13.i2.93322 PMID: 38648733

PMCID: PMC11034074.

2. European Association of Urology. EAU guidelines on

urolithiasis. Arnhem (NL): EAU Guidelines Oce; 2025.

3. Bingaman S, Leslie SW, Hinson MR. Obstructive uropathy. In:

StatPearls [Internet]. Treasure Island (FL): StatPearls

Publishing; 2025. Updated 2025 Nov 7.

4. Liu Y, Chen Y, Liao B, Luo D, Wang K, Li H, et al.

Epidemiology of urolithiasis in Asia. Asian

Urol.

2018;5(4):205-214. https://doi.org/10.1016/j.ajur.2018.08.007

PMID: 30310968 PMCID: PMC6177270.

5. Zul Khairul Azwadi I, Norhayati MN, Abdullah MS.

Percutaneous nephrostomy versus retrograde ureteral stenting

for acute upper obstructive uropathy: a systematic review and

meta-analysis.

Sci

Rep.

2021;11(1):6613.

https://doi.org/10.1038/s41598-021-86136-y PMID: 33758268

PMCID: PMC7988020.

6. Fischer KM, Louie M, Mucksavage P. Ureteral stent discomfort

and its management. Curr Urol Rep. 2018;19(8):64.

https://doi.org/10.1007/s11934-018-0818-8 PMID: 30062655.

7. Radecka E, Magnusson A. Complications associated with

percutaneous nephrostomies: a retrospective study. Acta Radiol.

2004;45(2):184-188.

LIMITATIONS

https://doi.org/10.1080/02841850410003671 PMID: 15204319.

8. Moon YJ, Jun DY, Jeong JY, Cho S, Lee JY, Jung HD.

Percutaneous nephrostomy versus ureteral stent for severe

urinary tract infection with obstructive urolithiasis: a systematic

review and meta-analysis. Medicina (Kaunas). 2024;60(6):861.

https://doi.org/10.3390/medicina60060861 PMID: 38930539

PMCID: PMC11246501.

Treatment allocation was not randomized. Residual

confounding and indication bias may therefore remain

despite multivariable adjustment. The study was

conducted at a single center. Follow-up was limited to

15 days, so long-term outcomes were not assessed. The

female subgroup was smaller than the male subgroup,

April - June 2026

J Gandhara Med Dent Sci

To Compare the Eectiveness of Percutaneous Nephrostomy

9. Cardoso A, Coutinho A, Neto G, Anacleto S, Tinoco CL, 16. Chitale SV, Scott-Barrett S, Ho ETS, Burgess NA. The

Morais N, et al. Percutaneous nephrostomy versus ureteral stent

management of ureteric obstruction secondary to malignant

pelvic disease. Clin Radiol. 2002;57(12):1118-1121.

https://doi.org/10.1053/crad.2002.1046 PMID: 12475535.

in hydronephrosis secondary to obstructive urolithiasis:

systematic review and meta-analysis. Asian Urol.

2024;11(2):261-270. https://doi.org/10.1016/j.ajur.2023.03.007 17. Gebreselassie KH, Adamu TA, Beyene AD. Ureteral stenting in

PMID: 37080201.

patients with locally advanced cervical cancer: predictors of low

success rate. Gynecol Oncol Rep. 2024;55:101491.

https://doi.org/10.1016/j.gore.2024.101491 PMID: 39051674

PMCID: PMC11271139.

10. Ahmad MU, Siddiqui S, Ashraf FA, Khan MS, Somani BK,

Nabi G, et al. Retrograde ureteral stents versus percutaneous

nephrostomy in the management of malignant ureteral

obstruction: a systematic review and meta-analysis. Urology. 18. Shvero A, Haier M, Mahmud H, Dotan ZA, Winkler H,

2024;192:158-167.

Kleinmann N. Quality of life with tandem ureteral stents

compared to percutaneous nephrostomy for malignant ureteral

obstruction. Support Care Cancer. 2022;30(11):9541-9548.

https://doi.org/10.1007/s00520-022-07354-2 PMID: 35997861.

https://doi.org/10.1016/j.urology.2024.05.042 PMID: 38831148.

11. Wang X, Ji X. Sample size estimation in clinical research: from

randomized controlled trials to observational studies. Chest.

2020;158(1

Suppl):S12-S20.

https://doi.org/10.1016/j.chest.2020.03.010 PMID: 32658663.

12. Ahmad I, Pansota MS, Tariq M, Saleem MS, Tabassum SA,

Hussain A. Comparison between double-J ureteral stenting and

percutaneous nephrostomy in obstructive uropathy. Pak J Med

AUTHORS CONTRIBUTION

Ishtiaq Ur Rehman - Concept & Design; Data Acquisition;

Drafting Manuscript; Supervision; Final Approval

Murad Ali - Concept & Design; Data Acquisition; Drafting

Manuscript; Final Approval

Sci.

2013;29(3):725-729.

PMID: 24353646

https://doi.org/10.12669/pjms.293.3563

PMCID: PMC3809319.

Adil Muhammad - Concept & Design; Data Acquisition; Data

Analysis/Interpretation; Drafting Manuscript; Final Approval

Muhammad Danish - Concept & Design; Data Acquisition;

Drafting Manuscript; Final Approval

Asghar Ali - Concept & Design; Data Acquisition; Drafting

Manuscript; Critical Revision; Final Approval

Syed Abdul Basit Ali Shah - Concept & Design; Data

Acquisition; Drafting Manuscript; Final Approval

Pir Sabir Shah - Concept & Design; Data Acquisition; Data

Analysis/Interpretation; Drafting Manuscript; Final Approval

13. Shah M, Blest F, Blackmur J, Laird A, Dawson S, Aning J.

Malignant upper urinary tract obstruction in cancer patients: a

systematic review. BJUI Compass. 2024;5(5):405-416.

https://doi.org/10.1002/bco2.340 PMID: 38940741 PMCID:

PMC11251049.

14. Ali AS, Mahnoor A, Basharat MA, Bilal M, Abrar M, Liaqat K.

Percutaneous nephrostomy audit: evaluating quality and

technical prociency.

2025;15(4):389-392.

Bahria Univ Med Dent Coll.

15. Heo JE, Jeon DY, Lee J, Han HH, Jang WS. Prediction of stent

failure for malignant ureteral obstruction in non-urological

The authors accept responsibility for all aspects of the work

and will ensure that any concerns regarding the accuracy or

integrity of any part are properly investigated and resolved.

cancer.

Yonsei

Med

2023;64(11):665-669.

PMID: 37730333

https://doi.org/10.3349/ymj.2023.0117

PMCID: PMC10571561.

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