Percutaneous nephrostomy in non-dilated kidneys for iatrogenic ureteral injuries

Öz

Amaç: Perkütan nefrostomi, iyatrojenik üreter yaralanmalarının tedavisinde çok önemli bir seçenektir. Ancak bu hastalarda pelvikaliseal sistem dilate olmadığı için işlem zordur. Bu çalışmanın amacı dilate olmayan böbreklerde perkütan nefrostomi deneyimimizi paylaşmaktır. Gereç ve Yöntemler: İatrojenik üreter yaralanması olan 14 hasta (10 kadın ve 4 erkek) çalışmaya dahil edildi. Bu hastaların 10'u jinekolojik ve 4’ü ürolojik cerrahi sırasında iyatrojenik üreter yaralanması geçirdi. Ultrasonografi ve floroskopi rehberliğinde toplam 17 nefrostomi işlemi (3 bilateral) gerçekleştirildi. İşlem öncesi pelvikaliseal sistemde dilatasyonu sağlamak için intravenöz diüretik infüzyonu uygulandı. İşlemde böbreğe giriş için daha ince iğne ve introduser sistem kullanıldı. Bulgular: Diüretik infüzyon sonrası 10 işlemde renal pelviste 5 mm'den fazla dilatasyon sağlandı ve tüm bu işlemlerde nefrostomi kateteri yerleştirilmesi başarılı oldu. Diğer 7 işlemde 5 mm'den az dilatasyon sağlandı ve bu işlemlerin 4'ünde (%23,5) nefrostomi kateteri yerleştirilmesi başarısız oldu. Teknik başarı oranı %76,5 idi ve majör komplikasyon gözlenmedi. Minör komplikasyon olarak 17 işlemin 5'inde (%29,4) minimal perirenal hematom meydana geldi. Sonuç: Perkütan nefrostomi, dilate pelvikaliksiyel sistemler için yüksek başarı ve düşük komplikasyon oranları ile basit bir işlemdir. Öte yandan dilate olmayan böbreklerde işlem genellikle zordur ve komplikasyonların sıklığı ve işlemsel başarısızlık oranı yüksektir.

Anahtar Kelimeler

• Perkütan nefrostomi
• dilate olmayan pelvikalisiyel sistem
• üreter yaralanması

Percutaneous nephrostomy in non-dilated kidneys for iatrogenic ureteral injuries

Öz

Aim: Percutaneous nephrostomy is a crucial option in the treatment of iatrogenic ureter injuries. However, in these patients, the procedure is difficult since the pelvicalyceal system is not dilated. The aim of this study is to share our percutaneous nephrostomy experience in non-dilated kidneys. Materials and Methods: Fourteen patients (10 females and 4 males) with iatrogenic ureter injury were included in the study. As the cause of the injury, ten of these patients had gynecological surgery where four had urological surgery. A total of 17 nephrostomy procedures (3 bilateral) were performed under ultrasonography and fluoroscopy guidance. In order to provide dilatation in pelvicalyceal system before the procedure, intravenous diuretic infusion was applied. In the procedure, a thinner needle and introducer system was used for the kidney access. Results: After diuretic infusion, dilatation more than 5 mm in renal pelvis was achieved in 10 procedures and nephrostomy catheter placement was successful in all of these procedures. Less than 5 mm dilatation was achieved in other 7 procedures and nephrostomy catheter placement was unsuccessful in 4 of these procedures (23.5%). Technical success rate was 76.5% and no major complications were observed. Minimal perirenal hematoma occurred in 5 of 17 procedures (29.4%) as a minor complication. Conclusion: Percutaneous nephrostomy is a simple procedure with high success and low complication rates for dilated pelvicalyceal systems. On the other hand, in non-dilated kidneys, the procedure is usually difficult, and the frequency of complications and the rate of procedural failure is high.

Anahtar Kelimeler

• Percutaneous nephrostomy
• non-dilated pelvicalyceal system
• ureteral injury

Kaynakça

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