Abstract
We investigated the characteristics and management of patients with intravenous misplacement of a nephrostomy tube. Between July 2007 and July 2013, 4148 patients with urolithiasis underwent percutaneous nephrolithotomy (PCNL) in our hospital. Intravenous misplacement of a nephrostomy tube occurred in two of these patients. Another patient with intravenous misplacement of a nephrostomy tube, who underwent PCNL in another hospital, was transferred to our hospital. The data of the three patients were retrospectively analyzed. The incidence of intravenous misplacement of a nephrostomy tube following PCNL was 0.5% (2/4148) at our hospital. A solitary kidney was present in one of the three patients. The tip of tube was located into the inferior vena cava (IVC) in two patients and into the renal vein in one patient. All three patients were successfully managed with strict bed rest, intravenous antibiotics and one-step (one patient) or two-step (two patients) tube withdrawal under close monitoring. None of the patients underwent antithrombotic therapy. The original operations were performed successfully under close observation in two patients and changed to another operation in one patient. All patients were discharged uneventfully. The incidence of intravenous misplacement of a nephrostomy tube following PCNL is 0.5% at our hospital. Intravenous nephrostomy tube misplacement is an uncommon complication of PCNL. A solitary kidney may render patients susceptible to this complication. Most patients may be managed conservatively with strict bed rest, intravenous antibiotics and one-step or two-step tube withdrawal under close monitoring.
Highlights
Percutaneous nephrolithotomy (PCNL) was introduced by Fernström and Johansson in 1976 [1], and is an important approach for removing kidney stones
We report our experience with three cases of intravenous nephrostomy tube misplacement following PCNL and review the few such cases published in the literature
We retrospectively reviewed the records of patients who were treated for urolithiasis in our hospital between July 2007 and July 2013, and identified 4148 patients who underwent PCNL
Summary
Percutaneous nephrolithotomy (PCNL) was introduced by Fernström and Johansson in 1976 [1], and is an important approach for removing kidney stones. A recent study demonstrated an increase in PCNL use in the United States over the last decade [2]. PCNL is an established procedure, major complication rates of up to 7% have been reported [3]. There has been an increase in surgical complications over the last decade [2]. Intravenous misplacement of a urologic catheter is an uncommon complication of percutaneous renal surgery [2,3,4,5,6]. Few publications have reported on the intravenous misplacement of a nephrostomy tube. We report our experience with three cases of intravenous nephrostomy tube misplacement following PCNL and review the few such cases published in the literature
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