4:42 PM, Abstract No. 65 - Pediatric percutaneous nephrostomy - a multi-center experience

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To describe the technique, outcomes, and complication rates of percutaneous nephrostomy (PN) procedures performed at four tertiary pediatric centers. 675 PN procedures performed on 441 patients (mean age: 6 years, range: 0.002-18yrs; mean weight: 24kg, range: 0.7-112kg), over an 11 year period, were retrospectively analyzed. The most frequent indications included hydronephrosis (65%), calculus (16%), and infection (14%). Most commonly, the patients had severe (45%) or moderate (32%) hydronephrosis. Technical success was 99% (n=668) with 7 failed insertions due to loss of access during tract dilatation (n=5) and staghorn calculi (n=2). 73% of procedures were performed under general anesthesia. 99% of procedures were performed under ultrasound/fluoroscopy. Of the 668 successful procedures, 561 (84%) were primary catheter insertions, while 107 (16%) were secondary insertions. The calyces accessed were: lower 47%, mid 28%, upper 12%, and renal pelvis 11%. 342 (51%) catheters were inserted in the right kidney and 324 (49%) in the left. 24 (4%) were placed in transplant kidneys. The catheter sizes were: 4-6F (n=209), 7-8F (n=352), and >10F (n=103). The average dwell time of nephrostomy catheters was 25 days (0-220d). The total primary catheter days were 14482 with an additional 2241 days with secondary procedures. Follow-up data were available for 653/668 (98%) procedures. 79% of catheters were electively removed. Salvage procedures (21%, 138/653) included: wire exchange 8.7%, nephroureteral stent/catheter conversion 8.8%, and tube upsizing 3.5%. Periprocedural complications occurred in 24% (163/675) of cases. One major complication that occurred was hematuria requiring transfusion. Minor complications included: self-limited hematuria in 19.5%, loss in initial access in 2.2%, site oozing in 1.2%, and post-obstructive diuresis in 1%. Mechanical complications i.e. tube related issues and urine leak occurred in (17%, n=116) and catheter related infectious complications occurred in 9% of procedures (n=63). This is the largest study to date that describes PN procedures in children. PN has been shown to be a safe and technically feasible procedure in the pediatric population.