Percutaneous nephrostomy in non-dilated kidneys for iatrogenic ureteral injuries

Abstract

Aim: Percutaneous nephrostomy is a crucial option in the treatment of iatrogenic ureter injuries. However, in these patients, the procedure is difficult since the pelvicalyceal system is not dilated. The aim of this study is to share our percutaneous nephrostomy experience in non-dilated kidneys. Materials and Methods: Fourteen patients (10 females and 4 males) with iatrogenic ureter injury were included in the study. As the cause of the injury, ten of these patients had gynecological surgery where four had urological surgery. A total of 17 nephrostomy procedures (3 bilateral) were performed under ultrasonography and fluoroscopy guidance. In order to provide dilatation in pelvicalyceal system before the procedure, intravenous diuretic infusion was applied. In the procedure, a thinner needle and introducer system was used for the kidney access. Results: After diuretic infusion, dilatation more than 5 mm in renal pelvis was achieved in 10 procedures and nephrostomy catheter placement was successful in all of these procedures. Less than 5 mm dilatation was achieved in other 7 procedures and nephrostomy catheter placement was unsuccessful in 4 of these procedures (23.5%). Technical success rate was 76.5% and no major complications were observed. Minimal perirenal hematoma occurred in 5 of 17 procedures (29.4%) as a minor complication. Conclusion: Percutaneous nephrostomy is a simple procedure with high success and low complication rates for dilated pelvicalyceal systems. On the other hand, in non-dilated kidneys, the procedure is usually difficult, and the frequency of complications and the rate of procedural failure is high.