Table 178, GRADE evidence profile: Retrograde stent versus percutaneous nephrostomy for malignant obstructions - Bladder Cancer

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Quality assessment							No of patients		Effect		Quality
No of studies	Design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	Urinary stent	Percutaneous nephrostomy	Relative (95% CI)	Absolute	Quality
Improvement of renal function (assessed with: Pre-procedure and post-procedure serum creatinine levels)
3¹	observational studies⁹	serious²	none	serious³	serious⁵	none	N=185	N=148	-		⊕○○○ VERY LOW
Symptom relief (assessed with: Residual hydronephrosis)
1⁴	observational studies⁹	serious²	none	serious³	serious⁵	none	43/66 (65.2%)	12/44 (27.3%)	RR 2.39 (1.43 to 3.99)	379 more per 1000 (from 117 more to 815 more)	⊕○○○ VERY LOW
Treatment-related morbidity (assessed with: Overall complication rate)
4⁶	observational studies⁹	none	none	serious³	serious⁵	none	45/156 (28.8%)	66/218 (30.3%)	-		⊕○○○ VERY LOW
Overall survival
2⁷	observational studies⁹	none	none	serious³	serious⁵	none	N=106 Average OS = 5.6 and 9.2 mo	N=71 Average OS = 5.9 and 6.5 mo	-		⊕○○○ VERY LOW
Subsequent chemotherapy
1⁸	observational studies⁹	none	none	serious³	serious⁵	none	11/52 (21.2%)		-		⊕○○○ VERY LOW
Subsequent cystectomy (follow-up 10-34 months)
1¹⁰	observational studies⁹	none	none	serious³	serious⁵	none	1/30 (3.3%)¹¹		-		⊕○○○ VERY LOW
Health-related quality of life
1¹²	observational studies	none	none	none	serious⁵	none	N=15	N=16	No differences in QoL at 7, 30 or 90 days.		⊕○○○ VERY LOW

1: Ku 2004; Kanou 2007; Chang 2012;
2: Malignant and benign obstructions not reported separately in Chang 2012;
3: Studies include patients with primary tumour sites other than the bladder;
4: Chang 2012;
5: Small sample size / low number of events limits precision;
6: Ku 2004; Kanou 2007; Wong 2007; Hubner 1993;
7: Kanou 2007; Wong 2007;
8: Hubner 1993;
9: Case series;
10: Chitale 2002;
11: One patient out of 30 with bladder cancer had a total cystectomy with urinary diversion for muscle-invasive disease after relief of obstruction in Chitale (2002);
12: Monsky 2013

Bladder Cancer: Diagnosis and Management.

NICE Guideline, No. 2.

National Collaborating Centre for Cancer (UK).

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