Percutaneous nephrostomy

This article highlights the indications, techniques, and complications of percutaneous nephrostomy. The authors' comments are based on their experience with more than 200 patients.     

Percutaneous nephrostomy in pyonephrosis

A series of 76 pyonephrotic kidneys in 73 patients were drained by percutaneous nephrostomy (PN) tube and examined to evaluate the contribution of this technique to the treatment of pyonephrosis. In 71 patients, clinical symptoms disappeared 24–48 h after the procedure. Two patients died from sepsis subsequent to anuria and underlying malignancy. Once the acute phase had remitted, interventional procedures were carried out in 39 cases, and constituted the definitive therapy in 36. In 32 cases, elective surgery was the definitive therapy, including the 3 cases not resolved after interventional procedures. Three patients in whom the obstruction cleared spontaneously following PN needed no additional treatment. Major complications included 6 cases of sepsis, all of which resolved satisfactorily with proper medical therapy.     

Percutaneous nephrostomy in pyonephrosis

A series of 76 pyonephrotic kidneys in 73 patients were drained by percutaneous nephrostomy (PN) tube and examined to evaluate the contribution of this technique to the treatment of pyonephrosis. In 71 patients, clinical symptoms disappeared 24-48 h after the procedure. Two patients died from sepsis subsequent to anuria and underlying malignancy. Once the acute phase had remitted, interventional procedures were carried out in 39 cases, and constituted the definitive therapy in 36. In 32 cases, elective surgery was the definitive therapy, including the 3 cases not resolved after interventional procedures. Three patients in whom the obstruction cleared spontaneously following PN needed no additional treatment. Major complications included 6 cases of sepsis, all of which resolved satisfactorily with proper medical therapy.     

Percutaneous nephrostomy in paediatrics

Percutaneous nephrostomy has been performed on 18 kidneys in 16 children with an age range of 1 day old to 14 years. The indications and techniques for percutaneous nephrostomy are described, the results are documented, and the effects of the procedure on the management of these patients are discussed. It is shown that percutaneous nephrostomy in paediatrics is a safe and reliable method for draining renal collecting systems in order to relieve obstruction, to assess renal function and to drain pyonephroses.     

Percutaneous nephrostomy — Technique

Urologic Radiology - Percutaneous nephrostomy is increasingly used for temporary relief of upper urinary tract obstruction. The technique described involves the use of angiographic catheters and...     

Percutaneous nephrostomy for endopyelotomy

Percutaneous full-thickness incision and stenting of the ureteropelvic junction (endopyelotomy) relieved obstruction in 33 (87%) of 38 patients treated over a 2-year period. Proper placement of the percutaneous nephrostomy tract through a posterior middle calyx and of a guidewire across the ureteropelvic junction is necessary in order to gain access to the narrowed area with a rigid cutting instrument. Except in patients with long lesions, high insertion of the ureter, or an enormously redundant renal pelvis, endopyelotomy gives excellent results with less morbidity and a shorter recovery time than open pyeloplasty.     

Percutaneous approach to nephrolithiasis

Percutaneous techniques were successful in removing stones from 101 (92%) of 110 kidneys attempted. Ultrasonic lithotripsy was used on 80 kidneys in 74 patients with stones 5-38 mm in diameter. The most common complication was incomplete disintegration with retained stone fragments. Twenty patients were treated by direct stone extraction, either by a stone basket or forceps. The average hospitalization for percutaneous stone removal of 10 days was not significantly different from that for open nephrolithotomy. However, patients undergoing percutaneous stone removal had only a 3-10 day convalescence after hospital discharge before returning to normal activity.     

Percutaneous nephrostomy for stone removal

Percutaneous nephrostomy placement was performed in 700 patients as the initial procedure in renal or ureteral calculus removal. The ease or complexity of the subsequent calculus removal procedure is directly dependent on precise nephrostomy placement. The most important technical factors in nephrostomy placement for calculus removal are selection of the nephrostomy track course, the track entry site into the renal collecting systems, intrarenal catheter and guidewire manipulations, and the final catheter positioning across the ureteropelvic junction and down the ureter.     

Percutaneous nephrostomy in infants and children

RATIONALE AND OBJECTIVES: The purpose of this study was to review the authors' experience with percutaneous nephrostomy during an 11-year period, paying special attention to indications and outcomes. MATERIAL AND METHODS: The records of 71 percutaneous nephrostomy procedures performed on 59 children at the authors' institution from January 1987 through December 1997 were retrospectively reviewed. In these children, ultrasonography was used for puncture and fluoroscopy for catheter insertion. Local anesthesia with sedation was used and later replaced by general anesthesia. Loop-end catheters were employed. The smallest patient weighed 1,200 g, and the mean patient age was 3.4 years. RESULTS: The mean duration of drainage was 60 days, and the longest time was 11 months. Indications were mainly obstructions, with congenital obstruction (n = 28) and postoperative obstruction (n = 26) being the most common. Obstructive pyelitis, malignancy, stone, renal cystic disease, trauma, and neurogenic bladder disturbance were also indications. No complications such as loss of the kidney, serious infection, or hemorrhage of clinical importance were observed. Obstruction was successfully relieved in all patients, but 12 kidneys and five hemikidneys did not recover function and were eventually removed. CONCLUSION: The percutaneous nephrostomy procedure is a safe technique that can be used successfully for short- and longterm drainage in all children, even in small infants and those with solitary kidneys, and is a valuable adjunct to surgery.     

Percutaneous catheter nephrostomy drainage--results of 70 procedures

Percutaneous nephrostomy (PCN) was performed 70 times in 46 patients. In the majority of cases the procedure was carried out as an emergency to relieve urinary obstruction. 20 of the patients had subsequent elective surgery, in others PCN allowed time for other forms of treatment to become effective. The technique carries a low mortality and morbidity, can be performed using either fluoroscopic or ultrasound imaging and should be available in all radiology departments.     

Percutaneous nephrostomy in neoplasm patients: when?]

The management of cancer patients with a lesion in its end stage is a clinical problem a satisfactory solution to which has not been found yet, because of the ethical and legal problems involved. The authors analyzed the survival rates of 218 patients with advanced neoplastic disease and obstructive renal failure who had undergone external/internal urinary diversion. One month after the procedure 20% of the patients were dead. The figure rose to 75% at 6 months and reached 98% at one year. Urinary diversion in cancer patients with renal failure is aimed not only at avoiding death and assuring a prolonged survival, but also at providing a good quality of life. Several clinical criteria are therefore analyzed which are used in the selection of patients to submit to nephrostomy. The most important factors seem to be the actual stage of the tumor, its primary location, the possibility of an effective antineoplastic therapy, and the patient's consent. Randomized long-term studies are still necessary to analyze not only survival rates but also quality of life after urinary diversion for obstructive renal failure.     

Percutaneous nephrostomy — Indicational and technical considerations

A series of 55 percutaneous nephrostomy patients is presented. Techniques and presently available catheter types are discussed as well as the specific problems arising when the procedure is used for urinary diversion in neoplastic disease.     

Percutaneous nephrostomy. A 5-year experience

The authors report their experience with percutaneous nephrostomy in the treatment of acute renal failure due to ureteral obstruction. One hundred and forty-three patients were treated with the positioning of 218 percutaneous nephrostomy catheters under fluoroscopic guidance. If performed as soon as possible, this percutaneous diversion provides a rapid improvement in renal function and allows an accurate staging of the lesion, as well as correct therapeutic indications. In many cases of urinary obstruction interventional radiology procedures represent a valid and successful alternative to more invasive palliative surgery.     

Percutaneous nephrostomy in neonates, infants, and children

In a 20-month period, 13 percutaneous nephrostomies were placed in 10 pediatric patients ranging in age from one day to six and one-half years. The procedure was successful in all cases with no significant complications. Final diagnoses included ureteropelvic junction obstruction, ureterovesical junction obstruction, posterior urethral valves, and pyonephrosis. Localization of the obstruction as detected on initial antegrade nephrostography was found to be incomplete or incorrect in three patients. In one patient, both ureteropelvic and ureterovesical junction obstruction were present. In the other two patients, the misdiagnosis probably related to the difficulty of filling a distended, obstructed ureter prior to drainage.     

Percutaneous nephrostomy in children and adolescents: outpatient management

PURPOSE: To determine if percutaneous nephrostomy can be performed safely as an outpatient procedure in children and adolescents. MATERIALS AND METHODS: Percutaneous nephrostomy was performed in 102 kidneys in 87 patients at 93 separate encounters. Patients were excluded from outpatient treatment if they presented with signs of infection, were hospitalized for other reasons, were undergoing additional endourologic stone procedures, had solitary kidneys or poor renal function, had social problems precluding outpatient care, or had a procedural complication. Follow-up was performed by means of direct communication and/or chart review. RESULTS: Successful outpatient percutaneous nephrostomy was performed in 39 (42%) of the 93 encounters. Reasons for exclusion included infection (n = 23), concomitant problems requiring hospitalization (n = 11), stone therapy (n = 7), solitary kidney with renal failure (n = 3), and social reasons (n = 10). No procedure-related complication occurred. No patient required readmission within 3 weeks for a tube- or procedure-related problem. CONCLUSION: Outpatient percutaneous nephrostomy can be safely performed in a selected group of patients.