Percutaneous nephrostomy insertion: outcome data from a propspective multi-operator study at a UK training centre

Abstract

AIM: To determine the success and complication rates of percutaneous nephrostomies (PCNs) performed at a UK training centre over a one-year period by different groups of operators. MATERIALS AND METHODS: During 2002, a total of 276 PCNs were performed in 190 patients by operators of varying experience. We employed two different techniques: (1) a “Seldinger” technique (ultrasound-guided puncture with a 19 G sheathed needle followed by guide-wire insertion and track dilatation to accommodate 8–12 F nephrostomy catheters), with or without fluoroscopic guidance, and (2) an ultrasound-guided “one-stab” technique using a 6 F Bonanno catheter. Selection of technique was according to configuration of the collecting system and whether the procedure was performed out of hours. RESULTS: There were 218 procedures using the Seldinger technique and 62 using the one-stab technique. The Seldinger technique and one-stab technique were compared: primary technical success rate was 98 versus 93%, the major complication rate was 4.1 versus 3.2%, the minor complication rate was 5 versus 13%, and tube complications, such as drainage catheter dislodgement and blockage, were 29.5 versus 17.7%, respectively. The 30-day mortality was 4.3%, none of which were procedure related. CONCLUSION: Based on data from the USA, proposed targets for primary technical success rates are 88–99%, major complications 4-8%, and minor complications 3–15%, and the results were within these target ranges. The ultrasound-guided one-stab technique is a quick and safe procedure in selected cases, and we recommend this method for temporary urinary diversion in cases with moderate to severe degrees of pelvicalyceal system dilatation. These data may help to form a baseline for outcome targets in the UK.