Ultrasound as a reliable guidance system for percutaneous nephrostomy.

Abstract

To determine the effectiveness and safety of ultrasound as a reliable guidance system for percutaneous nephrostomy (PCN). Quasi-experimental. Jinnah Postgraduate Medical Center, Karachi, Pakistan, from January 1997 to July 2005. One hundred and fifty-three PCN were performed in 140 patients, referred from the Department of Urology and Transplantation, JPMC. Out of 140 patients, 137 had obstructive uropathy (>1 cm dilated pelvicalyceal system) of different etiologies. Three patients with ureteral rupture (non dilated pelvicalyceal system) underwent PCN for urinary diversion in the surgical ICU. The technique involved a pre procedural scan, initial renal puncture, placement of a guide wire, tract dilation and placement of 8-12 F Nephrostomy tube, entirely under ultrasound guidance. The machine used was 'Just vision' or 'Eccocee' with 3.5 MHz variable frequency convex transducer. Effectiveness in terms of successful tube placement and safety in terms of complications were observed. Out of 153 patients there were 78 males and 62 females. The minimum age of patient was 13 years while maximum age was 68 years, all (100%) patients had successful placement of PCN. Minor complications like transient gross hematuria and small perinephric collection occurred in 13 cases (8.5%) but was dealt with effectively by conservative measures. No major complications like hemorrhage, sepsis or periorgan damage were encountered in any of the patients. Ultrasound was found to be a rapid, effective, radiation-free, portable and safe imaging modality with minimum rate of complications that could be used as a reliable guidance system for critical interventions like percutaneous nephrostomies without using fluoroscopic units.