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

## TL;DR

This study compares Malecot and pigtail catheters in ultrasound-guided nephrostomy procedures, finding Malecot catheters to have fewer displacements and reinterventions in complex cases.

## Contribution

The study provides new comparative evidence on catheter performance in ultrasound-guided nephrostomy, particularly in managing complex urinary obstructions.

## Key findings

- Malecot catheters had lower displacement rates (6% vs. 15%) and reintervention rates (26% vs. 59%) compared to pigtail catheters.
- Malecot catheters performed better in draining pus-laden obstructions (p<0.001) due to larger diameters.
- Complication rates were similar between the two catheter types, with mostly low-grade issues.

## Abstract

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.