Comparative Study of Safety and Outcomes of Malecot and Pigtail Catheters in Ultrasound-Guided Percutaneous Nephrostomy: A Single-Center Retrospective Analysis.

PURPOSE: Percutaneous nephrostomy (PCN) is a vital urological intervention to relieve urinary tract obstructions caused by stones, malignancies, or strictures, which can compromise renal function. PCN also facilitates urinary diversion in cases of leaks or fistulas. Catheter choice, such as Malecot (silicone) or pigtail (polyurethane), impacts outcomes, with complications like dislodgement and obstruction. This study compares the safety, efficacy, and patient outcomes of Malecot versus pigtail catheters in ultrasound-guided PCN.

MATERIALS AND

METHODS

A retrospective observational comparative analysis was conducted at the Department of Urology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India, from December 2022 to May 2025, involving 548 patients (248 Malecot, 300 pigtail) undergoing ultrasound-guided PCN for urinary obstruction due to urolithiasis, malignancy, or strictures. Demographic, procedural, and outcome data, including complication rates (per Clavien-Dindo classification), catheter displacement, and reintervention rates, were compared. Procedures utilized the Seldinger technique under ultrasound guidance. Statistical significance was assessed using p-values.

RESULTS

Baseline demographics (age, sex, and hydronephrosis grade) were comparable, though the pigtail group had a higher Charlson Comorbidity Index (p=0.038). Malecot catheters showed superior performance in draining pus-laden obstructions (114/248 vs. 88/300, p<0.001), attributed to larger diameters (10f predominant, p<0.001). Pigtail catheters had higher displacement rates (15% vs. 6%, p<0.01) and reintervention rates (59% vs. 26%, p<0.001). Complication rates were similar (p=0.076), predominantly low-grade. Procedure times and hospital stays were equivalent.

CONCLUSION

In ultrasound-guided PCN, Malecot catheters were associated with lower displacement and reintervention rates than pigtail catheters in managing complex urinary obstructions, particularly pyonephrosis. These findings suggest a potential role for Malecot catheters in selected high-risk cases, though larger, multicenter studies are needed to refine catheter selection protocols.