Indications and outcomes of the percutaneous nephrostomy at Urology-Andrology Teaching Hospital of CNHU-HKM in Cotonou

Abstract

Background: The percutaneous nephrostomy constitutes a backup remedy allowing the derivation of urine and thus cancelling the emergency, while waiting for adequate etiological treatment. The objective of this study was to determine indications and outcomes of the percutaneous nephrostomy at Urology-Andrology Teaching Hospital of the National Centre Academic Hospital Hubert KOUTOUKOU MAGA (CNHU-HKM) of Cotonou. Methods: It was a retrospective study carried out from January 1st, 2016 to May 30, 2020. Results: The placement of nephrostomy tubes has been indicated in 15.26% of urine derivations for the obstruction of the upper urinary tract. The average age of patients was 54.85 years with extremes of 28 and 70 years. The two sexes are interested in the same proportion, 10 cases for each. The average consultation time is 31.4 days with the extremes of 5 and 90 days. The obstruction was bilateral in 19 cases on 20. The gynaecological cancers were majority with 9 cases follow-up of those of the colon (4 cases), of the bladder (3 cases) and of the prostate (3 cases). The drainage was unilateral in 18 cases out of 20. The mean blood creatinine rate is 145.52 mg/l with extremes of 10 and 436 mg/l. Blood creatinine rate was pathological in 19 of our patients; it has been ameliorated among patients having an elevated initial creatinine blood level but without reaching normal values in 18 out of 19 patients. The lowest rates of creatinine blood level have been reached after 10.33 days with extremes of 2 and 23 days. After the percutaneous nephrostomy, the surgical abstention has been decided in 13 cases, the dialysis had been done in 5 cases, the reimplantation + installation of the probe double J in 1 case and the chemotherapy in 1 case. The main reason of death of the patients having undergone the nephrostomy was the ionic disorders (13 cases out of 18) mainly the hyperkalemia and the hyponatremia followed of anemia (3 cases out of 18) and of the uremic coma (2 cases out of 18). The middle duration of hospitalization after the drainage was of 16.85 days, with extremes of 1 and 50 days. The death occurred at 18 out of 20 patients and the middle period of survival was 31.25 days with extremes of 1 to 60 days. Conclusion: The percutaneous nephrostomy remains the beneficial alternative for the derivation of the upper urinary tract instead of the double J installation. Popularization of percutaneous nephrostomy would reduce the morbidity and mortality linked to complications of obstructive syndrome of the upper urinary tract; hence the need for awareness for early urological consultation