Abstract
Aim: To review the feasibility and performance of percutaneous nephrostomy (PCN) in a tertiary care teaching hospital and determine the success and complication rate and to compare it with the standard recommended by ACR-SIR-SPR guidelines.
Materials and Methods: We retrospectively reviewed 444 percutaneous nephrostomy in 344 patients performed from January 2010 to December 2012. All PCN performed in native kidney. Prophylactic antibiotic was given to all patients. Patients having coagulation abnormalities were corrected before the procedure. All cases had been carried out by experienced radiologists using a Seldinger technique under ultrasonography and fluoroscopy guidance. Percutaneous nephrostomy was considered successful if the catheter was placed in the pelvis and drained urine or the content of pelvicalyceal system. Indication, success rate and complication rate were noted.
Results: Most common indication was obstructive hydronephrosis (79.3%) due to various causes. Overall success rate was 98%; it was 98.2% for dilated system and 88.9% for non dilated system. Total complication rate was noted in 66 (14.9%) PCN, out of which 40 (9.01%) procedure related and 26 (5.9%) catheter related. Major complications were noted in 9 (2.03%).
Conclusion: Percutaneous nephrostomy using Seldinger technique under both ultrasonography and fluoroscopy guidance in the hands of experienced radiologists is a safe and effective minimally invasive procedure with high success rate and low rate of complications.
Keywords: Percutaneous nephrostomy, Seldinger technique, ultrasonography, fluoroscopy, pelvicalyceal system.
References
- Goodwin WE, Casey WC,Woolf W. Percutaneous trocar (needle) nephrostomy in hydronephrosis. J Am Med Assoc 1955;157(11):891–4.
- Hausegger KA, Portugaller HR. Percutaneous nephrostomy and antegrade ureteral stenting: technique–indications–complications. Eur Radiol 2006;16(9):2016–30.
- Saad WE, Moorthy M, Ginat D. Percutaneous nephrostomy: native and transplanted kidneys. Tech Vasc Interv Radiol. 2009;12(3):172-92.
- Farrell TA, Hicks ME: A review of radiologically guided percutaneous nephrostomies in 303 patients. J Vasc Interv Radiol 1997; 8:769-774
- Radecka E, Magnusson A: Complications associated with percutaneous nephrostomies. A retrospective study. Acta Radiol 2004;45:184-188
- Ramchandani P, Cardella JF et al. Quality improvement guidelines for percutaneous nephrostomy. J Vasc Interv Radiol. 2003 14(9 Pt 2): S277-281.
- Stables DP. Percutaneous nephrostomy: techniques, indications, and results. Urol Clin North Am. 1982; 9(1): 15-29.
- Dyer RB, Regan JD, Kavanagh PV, Khatod EG, Chen MY, Zagoria RJ. Percutaneous nephrostomy with extensions of the technique: step by step. Radiographics. 2002;22(3):503-25.
- Rameysh D. Mahmood, Lee Yizhi and Mark Tan M.L. (2012). Percutaneous Nephrostomy in Chronic Kidney Disease, Prof. Monika Göőz (Ed.), ISBN: 978-953 51-0171-0, InTech, DOI: 10.5772/25162. 297-314. Available from: http://www.intechopen.com/books/chronic-kidney-disease/percutaneous nephrostomy
- Montanari E, Serrago M, Esposito N, Rocco B, Kartalas-Goumas I, Del Nero A, Zanetti G, Trinchieri A, Pisani E. Ultrasound-fluoroscopy guided access to the intrarenal excretory system. Ann Urol (Paris). 1999;33(3):168-81
- Agostini S, Dedola GL, Gabbrielli S, Masi A. A new percutaneous nephrostomy technique in the treatment of obstructive uropathy. Radiol Med. 2003;105(5-6):454 61
- 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(2):553-8.
- Lee WJ, Mond DJ, Patel M, Pillari GP. Emergency percutaneous nephrostomy: technical success based on level of operator experience. J Vasc Interv Radiol 1994; 5:327–330.
- Lee WJ, Patel U, Patel S, Pillari GP. Emergency percutaneous nephrostomy: results and complications. J Vasc Interv Radiol. 1994;5(1):135-139
- Gray RR, So CB, McLoughlin RF, Pugash RA, Saliken JC, Macklin NI. Outpatient percutaneous nephrostomy. Radiology 1996; 198:85–88.
- Gupta S, Gulati M, Uday Shankar K, Rungta U, Suri S. Percutaneous nephrostomy with real-time Sonographic guidance. Acta Radiol 1997; 38:454–457.
- von der Recke P, Nielsen MB, Pedersen JF. Complications of ultrasound-guided nephrostomy: a 5-year experience. Acta Radiol 1994; 35:452–454.
- ACR–SIR–SPR practice guideline for the performance of Percutaneous nephrostomy. http://www.acr.org/./media/ACR/Documents/PGTS/guidelines/Percutaneous nephrostomy;2011 [accessed 7.3.2013]
- Clark TW, Abraham RJ, Flemming BK. Is routine micropuncture access necessary for percutaneous nephrostomy? A randomised trial. Canad Assoc Radiol J 2002;53:87—91.
- Lewis S, Patel U. Major complications after percutaneous nephrostomy – lessons from a department audit. Clin Radiol 2004;59(2):171–9.
- Cochran ST, Barbaric ZL, Lee JJ, Kashfian P. Nephrostomy tube placement: an outpatient procedure? Radiology 1991; 179:843–847.
- Zagoria RJ, Dyer RB. Do’s and don’t’s of percutaneous nephrostomy. Acad Radiol 1999; 6:370–377.
- Ferral H, Stackhouse DJ, Bjarnason H, Hunter DW, Castaneda-Zu´n˜ iga WR. Complications of percutaneous nephrostomy tube placement. Semin Intervent Radiol 1994; 11:198–206.
- Mahaffey KG, Bolton DM, Stoller ML. Urologist directed percutaneous nephrostomy tube placement. J Urol 1994; 152:1973–1976.
Corresponding Author
Dr Hira Lal
Additional Professor, Department of Radiodiagnosis
Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareily Road, Lucknow- 226014, India
Phone: 91-0522-2494583, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.