Radiologically guided percutaneous nephrostomy: A 6-year single-center experience

Year 2019, Volume: 4 Issue: 3, 142 - 147, 01.12.2019

Mehmet Şeker , Türkmen Turan Çiftçi , Devrim Akıncı Okan Akhan

https://doi.org/10.25000/acem.605006

Abstract

Aim: To retrospectively analyze the
indications, underlying pathologies, technical success rate, complications and
benefit of percutaneous nephrostomies in a single centre.

Materials and Methods: Data of 578 patients
who underwent radiologically guided percutaneous nephrostomy between January 1999 and December 2004 were retrospectively reviewed. The mean age
of the patients was 42.5 years (range, 6 days–90 years). The indications were urinary obstruction without urinary infection
(77.9%),  urinary obstruction with
urinary infection (13.1%), urinary diversion (6.9%) and diagnostic testing
(2.1%).

Results: The technical success rate was
99.4%. There was no procedure related mortality. Major
hemorrhage or sepsis were not observed in children. Major hemorrhage occurred in 1.55% and sepsis occured in 2.65% of adult patients. Catheter dislodgement was the commonest
complication with an overall rate of 11.4%. In 7.2% patients, percutaneous
nephrostomy was successful in managing patients without further intervention.  36.5% of patients had surgery and 14.7%  had ureteral stenting as definitive
treatment. 

Conclusion: Radiologically guided percutaneous
nephrostomy, can be used effectively, and safely in a wide variety of
indications with high technical success and low complications rates.

Keywords

Percutaneous nephrostomy, urinary system obstruction, urinary leakage, urinary fistula, interventional radiology

Görüntüleme kılavuzluğunda perkütan nefrostomi: 6 yıllık tek merkez deneyimi

Abstract

Amaç: Perkütan nefrostomilerin,
endikasyonlarını, altta yatan patolojileri, teknik başarı oranını, komplikasyonları
ve genel faydalarını retrospektif olarak incelemek.

Materyal ve Metod: Ocak 1999 ile Aralık 2004
tarihleri arasında görüntüleme kılavuzluğunda perkütan nefrostomi yapılan 578
hastanın verileri retrospektif olarak incelenmiştir. Hastaların ortalama yaşı
42,5 yıl idi (6 gün–90 yıl).  İşlem
endikasyonları üriner enfeksiyon olmadan obstrüksiyon varlığı (% 77,9), üriner
enfeksiyon ile beraber obstrüksiyon varlığı (%13,1), üriner diversiyon (%6,9)
ve böbrek fonksiyonları değerlendirme (%2,1) idi.

Bulgular: Teknik başarı oranı % 99,4 idi.
İşlemle ilişkili mortalite izlenmedi. Çocuklarda major hemoraji ya da sepsis
görülmemişti. Erişkin hastalarda major kanama oranı % 1,55, sepsis oranı ise %2,65
idi. Kateter dislokasyonu en sık ortaya çıkan komplikasyondu ve oranı toplamda
%11,4 idi. Hastaların %7,2'sinde başka girişim yapılmadan perkütan nefrostomi
ile başarılı tedavi sağlandı. Hastaların %36,5'inde cerrahi ile ve %14,7'sinde
ise üreteral stent yerleştirilerek kesin tedavi sağlandı.

Sonuç: Radyoloji kılavuzluğunda yapılan perkütan
nefrostomi, yüksek teknik başarı ve düşük komplikasyon oranları ile çok çeşitli
endikasyonlarda etkili ve güvenli bir şekilde kullanılabilir.

Keywords

Perkütan nefrostomi, üriner sistem obstrüksiyonu, üriner sistem kaçağı, üriner fistül, girişimsel radyoloji

References

• 1. Dagli M, Ramchandani P. Percutaneous nephrostomy: technical aspects and indications. Semin Interv Radiol. 2011;28:424–37.
• 2. Pabon-Ramos WM, Dariushnia SR, Walker TG, d’Othée BJ, Ganguli S, Midia M, et al. Quality improvement guidelines for percutaneous nephrostomy. J Vasc Interv Radiol. 2016;27:410–4.
• 3. Ramchandani P, Cardella JF, Grassi CJ, Roberts A.C, Sacks D, Schwartzberg M.S, et al. Quality improvement guidelines for percutaneous nephrostomy. J Vasc Interv Radiol. 2003;14:277–81.
• 4. Young M, Leslie SW. Percutaneous Nephrostomy. [Updated 2019 Jun 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493205/
• 5. Efesoy O, Saylam B, Bozlu M, Çayan S, Akbay E. The results of ultrasound-guided percutaneous nephrostomy tube place¬ment for obstructive uropathy: A single-centre 10-year experience. Turk J Urol 2018; 44: 329-34.
• 6. Lodh B, Gupta S, Singh AK, Sinam RS. Ultrasound guided direct percutaneous nephrostomy (pcn) tube placement: stepwise report of a new technique with its safety and efficacy evaluation. J Clin Diagn Res 2014;8:84-7.
• 7. Montvilas P, Solvig J, Johansen TE. Single-centre review of radiologically guided percutaneous nephrostomy using “mixed” technique: success and complication rates. Eur J Radiol. 2011;80:553–8.
• 8. Farrell TA, Hicks ME. A review of radiologically guided percutaneous nephrostomies in 303 patients. J Vasc Interv Radiol. 1997;8:769–74.
• 9. Radecka E, Magnusson A. Complications associated with percutaneous nephrostomies. A retrospective study. Acta Radiol. 2004;45:184–8.
• 10. Gupta DK, Chandrasekharam VV, Srinivas M, Bajpai M. Percutaneous nephrostomy in children with ureteropelvic junction obstruction and poor renal function. Urology. 2001;57:547–50.
• 11. Hogan M, Coley BD, Jayanthi VR, Shiels WE. Percutaneous Nephrostomy in Children and Adolescents: Outpatient Management. Radiology 200;218:207–10.
• 12. Chitale SV, Scott-Barrett S, Ho ET, Burgess NA. The management of ureteric obstruction secondary to malignant pelvic disease. Clin Radiol. 2002;57:1118–21.
• 13. Meira MDS, Barbosa PNVP, Bitencourt AGV, Almeida MFA, Tyng CJ, Costa MAF et al. Retrospective analysis of computed tomography-guided percutaneous nephrostomies in cancer patients. Radiol Bras. 2019;52:148–54.
• 14. Millward SF. Percutaneous nephrostomy: a practical approach. J Vasc Interv Radiol 2000;11:955-64.
• 15. Patel U, Hussain FF. Percutaneous nephrostomy of nondilated renal collecting systems with fluoroscopic guidance: technique and results. Radiology. 2004;233:226-33.
• 16. Gayer G, Zissin R, Apter S, Garniek A, Ramon J, Kots E, et al. Urinomas caused by ureteral injuries: CT appearance. Abdom Imaging. 2002;27:88–92.
• 17. Avritscher R, Madoff DC, Ramirez PT, Wallace MJ, Ahrar K, Morello FA, et al. Fistulas of the lower urinary tract: percutaneous approaches for the management of a difficult clinical entity. Radiographics, 2004;24:S217–S36.
• 18. Titton RL, Gervais DA, Hahn PF, Harisinghani MG, Arellano RS, Mueller PR. Urine leaks and urinomas: diagnosis and imaging-guided intervention. Radiographics 2003;23:1133–47.
• 19. Hunter DW, Castaneda-Zuniga WR, Coleman CC, Herrera M, Amplatz K. Percutaneous techniques in the management of urological complications in renal transplant patients. Radiology. 1983;148:407-12.
• 20. Gregory MC, Micklos J, Miller FJ, et al. Percutaneous dilatation and stenting of ureteral stenosis in renal transplantation. Clin Trans. 1988;2:107-9c.
• 21. Patel U, Hussain FF. Percutaneous nephrostomy of nondilated renal collecting systems with fluoroscopic guidance: technique and results. Radiology. 2004;233:226-33.
• 22. Ferral H, Stackhouse DJ, Bjarnason H, Hunter DW, Castaneda-Zúñiga WR, et al. Complications of percutaneous nephrostomy tube placement. Semin Intervent Radiol 1994;11:198–206.
• 23. Cochran ST, Barbaric ZL, Lee JJ, Kashfian P. Nephrostomy tube placement: an outpatient procedure? Radiology 1991;179:843–7.
• 24. Moon E, Tam MD, Kikano RN, Karuppasamy K. Prophylactic antibiotic guidelines in modern interventional radiology practice. Semin Intervent Radiol. 2010;27:327–37.
• 25. Smith TP, Hunter DW, Letourneau JG, Cragg AH, Darcy MD, Castaneda-Zuniga WR, et al. Urine leaks after renal transplantation: Value of percutaneaous pyelography and drainage for diagnosis and treatment. AJR Am J Roentgenol. 1988;151:511–3.
• 26. Sim LS, Tan BS, Yip SK, Ng CK, Lo RH, Yeong KY, et al. Single centre review of radiologically-guided percutaneous nephrostomies: a report of 273 procedures. Ann Acad Med Singapore 2002;31:76-80.
• 27. Wah TM, Weston MJ, Irving HC. Percutaneous nephrostomy insertion: outcome data from a prospective multi-operator study at a UK training centre. Clin Radiol. 2004;59:255–61.